SB 529
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AN ACT
RELATING TO INSURANCE; REQUIRING INSURANCE COVERAGE FOR
HEARING AIDS FOR ELIGIBLE CHILDREN.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. A new section of the Health Care Purchasing
Act is enacted to read:
"HEARING AID COVERAGE FOR CHILDREN REQUIRED.--
A. Group health care coverage, including any form
of self-insurance, offered, issued or renewed under the
Health Care Purchasing Act shall provide coverage for a
hearing aid and any related service for the full cost of one
hearing aid per hearing-impaired ear up to two thousand two
hundred dollars ($2,200) every thirty-six months for hearing
aids for insured children under eighteen years of age or
under twenty-one years of age if still attending high school.
The insured may choose a higher priced hearing aid and may
pay the difference in cost above the
two-thousand-two-hundred-dollar ($2,200) limit as provided in
this subsection without financial or contractual penalty to
the insured or to the provider of the hearing aids.
B. Each insurer that delivers, issues for delivery
or renews under the Health Care Purchasing Act any group
health care coverage, including any form of self-insurance,
may make available to the policyholder the option of
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purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear
molds as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same group health care coverage,
including any form of self-insurance.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 2. A new section of the New Mexico Insurance
Code, Section 59A-22-34.5 NMSA 1978, is enacted to read:
"59A-22-34.5. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
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provide coverage for a hearing aid and any related service
for the full cost of one hearing aid per hearing-impaired ear
up to two thousand two hundred dollars ($2,200) every
thirty-six months for hearing aids for insured children under
eighteen years of age or under twenty-one years of age if
still attending high school. The insured may choose a higher
priced hearing aid and may pay the difference in cost above
the two-thousand-two-hundred-dollar ($2,200) limit as
provided in this subsection without financial or contractual
penalty to the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
insurance policy, health care plan or certificate of health
insurance may make available to the policyholder the option
of purchasing additional hearing aid coverage that exceeds
the services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear
molds as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
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deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 3. A new section of the New Mexico Insurance
Code, Section 59A-23-7.6 NMSA 1978, is enacted to read:
"59A-23-7.6. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. A blanket or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
provide coverage for a hearing aid and any related service
for the full cost of one hearing aid per hearing-impaired ear
up to two thousand two hundred dollars ($2,200) every
thirty-six months for hearing aids for insured children under
eighteen years of age or under twenty-one years of age if
still attending high school. The insured may choose a higher
priced hearing aid and may pay the difference in cost above
the two-thousand-two-hundred-dollar ($2,200) limit as
provided in this subsection without financial or contractual
penalty to the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state a blanket or group health insurance
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policy, health care plan or certificate of health insurance
may make available to the policyholder the option of
purchasing additional hearing aid coverage that exceeds the
services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear
molds as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 4. A new section of the New Mexico Insurance
Code, Section 59A-46-38.5 NMSA 1978, is enacted to read:
"59A-46-38.5. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health maintenance
organization contract delivered, issued for delivery or
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renewed in this state shall provide coverage for a hearing
aid and any related service for the full cost of one hearing
aid per hearing-impaired ear up to two thousand two hundred
dollars ($2,200) every thirty-six months for hearing aids for
insured children under eighteen years of age or under
twenty-one years of age if still attending high school. The
insured may choose a higher priced hearing aid and may pay
the difference in cost above the
two-thousand-two-hundred-dollar ($2,200) limit as provided in
this subsection without financial or contractual penalty to
the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
maintenance organization contract may make available to the
policyholder the option of purchasing additional hearing aid
coverage that exceeds the services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear
molds as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico. A health maintenance organization has the
discretion to determine the provider of hearing aids with
which it contracts. Nothing in this section shall be
construed to preclude a health maintenance organization from
conducting medical necessity or utilization review for
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hearing aids and related services.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 5. A new section of the New Mexico Insurance
Code, Section 59A-47-37.1 NMSA 1978, is enacted to read:
"59A-47-37.1. HEARING AID COVERAGE FOR CHILDREN
REQUIRED.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance delivered
or issued for delivery in this state shall provide coverage
for a hearing aid and any related service for the full cost
of one hearing aid per hearing-impaired ear up to two
thousand two hundred dollars ($2,200) every thirty-six months
for hearing aids for insured children under eighteen years of
age or under twenty-one years of age if still attending high
school. The insured may choose a higher priced hearing aid
and may pay the difference in cost above the
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two-thousand-two-hundred-dollar ($2,200) limit as provided in
this subsection without financial or contractual penalty to
the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery
or renews in this state an individual or group health
insurance policy, health care plan or certificate of health
insurance may make available to the policyholder the option
of purchasing additional hearing aid coverage that exceeds
the services described in this section.
C. Hearing aid coverage offered shall include
fitting and dispensing services, including providing ear
molds as necessary to maintain optimal fit, provided by an
audiologist, a hearing aid dispenser or a physician, licensed
in New Mexico.
D. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
E. Coverage for hearing aids may be subject to
deductibles and coinsurance consistent with those imposed on
other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid"
means durable medical equipment that is of a design and
circuitry to optimize audibility and listening skills in the
environment commonly experienced by children."
Section 6. EFFECTIVE DATE.--The effective date of the
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provisions of this act is July 1, 2007.