SECTION 1. The legislature finds that approximately three to four out of every one thousand children born in Hawaii are identified as having permanent hearing loss. According to the National Institutes of Health, about one-third of Americans between the ages of sixty-five and seventy-five and around one-half of those older than seventy-five have some degree of hearing loss.

According to the Lions Club, the cost of a custom low- to mid-level analog or digital hearing aid begins around $2,000 or less, and the cost of a high-end hearing aid is around $3,000 or higher. Some people with a permanent conductive hearing loss, for whom conventional hearing aids are not appropriate, may benefit from amplification through bone conduction hearing aids, which can cost over $3,000. Furthermore, about 50 per cent of childhood hearing loss is due to genetic causes, meaning that more than one member in a family may need to wear hearing aids, thereby multiplying the financial hardship caused by the cost of purchasing hearing aids.

Currently, most health insurance plans in Hawaii cover the purchase of hearing aids, but the amount of coverage may be low. As a result, it is not unusual for people with hearing loss to choose to delay purchase or forgo the purchase of hearing aids because they are unable to pay for them. A 2005 study by the Better Hearing Institute, estimated that untreated hearing loss resulted in a loss of income per household of up to $12,000 per year. Hawaii QUEST and medicaid plans cover hearing aid purchases every two to three years and hearing aid evaluations, selection and fitting, hearing aid checks, hearing testing, ear molds, repairs, and batteries. However, federal medicare insurance plans do not cover hearing aid purchases and only cover hearing testing.

According to the American Speech-Language-Hearing Association, twenty states currently mandate insurance coverage for hearing aids. In states that specify the frequency of replacing hearing aids, the range is every two to five years, with thirteen states requiring replacement every three years. Fifteen states have parameters on the costs that the insurance companies must provide, ranging from $1,400 to $4,000 per ear or hearing aid.

The legislature further finds that the auditor published report No. 14-10, a sunrise study on the advisability of mandating insurance coverage for hearing aids, as proposed in S.B. No. 309, S.D. 1 (2014). The auditor found that most insurance plans in Hawaii already cover or plan to cover the cost of hearing aids in 2015 and that although the current coverage level may require a large co-payment, those insurance plans would still comply with S.B. No. 309, S.D. 1, since that legislation did not contain limits on coverage, frequency for replacing hearing aids, or costs covered by insurers.

The purpose of this Act is to require health insurance coverage in the State for hearing aids for people with all types of hearing loss and specify a minimum amount of coverage and frequency for replacement of hearing aids under the coverage.

SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431:10A- Coverage for hearing aids. (a) Each individual and group accident and health or sickness policy, contract, plan, or agreement issued or renewed in this State after December 31, 2015, other than an accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, dental, vision, or other limited benefit health insurance policy, shall provide, not as an employer option, coverage for the cost of hearing aids for the policyholder and individuals covered under the policy, contract, plan, or agreement.

(b) Hearing aid purchases covered under this section shall be subject to a maximum benefit of $1,500 per hearing-impaired ear every thirty-six months.

(c) The policyholder and individual covered under the policy, contract plan, or agreement may choose a hearing aid that is priced higher than the benefit payable under this section without financial or contractual penalty to the provider of the hearing aid.

(d) This section does not prohibit an entity subject to this section from providing coverage that is greater or more favorable to the policyholder and individuals covered under the policy, contract plan, or agreement.

(e) As of January 1, 2016, to the extent that the mandatory benefit requires benefits that exceed the essential health benefits specified under section 1302(b) of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), the specific benefits that exceed the specified essential health benefits shall not be required of a qualified health plan when the plan is offered in this State through the Hawaii health insurance exchange by a health carrier. Nothing in this section shall nullify the application of the mandatory benefit to plans offered outside the Hawaii health insurance exchange.

(f) Coverage required under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, and annual or maximum payment limits applicable to other similar coverage under the policy, contract, plan, or agreement.

(g) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year 2015 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2015.

(h) For the purposes of this section, "hearing aid" shall have the same meaning as in section 451A-1 and includes conventional and bone conduction hearing aids."

SECTION 3. Chapter 432:1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432:1- Coverage of hearing aids. (a) Each individual and group hospital or medical service plan, policy, contract, or agreement issued or renewed in this State after December 31, 2015, shall provide, not as an employer option, coverage for the cost of hearing aids for the member and individuals covered under the individual and group hospital or medical service plan, policy, contract, or agreement.

(b) Hearing aid purchases covered under this section shall be subject to a maximum benefit of $1,500 per hearing-impaired ear every thirty-six months.

(c) The members and individuals covered under the policy, contract plan, or agreement may choose a hearing aid that is priced higher than the benefit payable under this section without financial or contractual penalty to the provider of the hearing aid.

(d) This section does not prohibit an entity subject to this section from providing coverage that is greater or more favorable to the member and individuals covered under the policy, contract plan, or agreement.

(g) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2015 when annual information is made available to policyholders, or in any other mailing to members, but in no case later than December 31, 2015.

(h) For the purposes of this section, "hearing aid" shall have the same meaning as in section 451A-1 and includes conventional and bone conduction hearing aids."

SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, [~~431:10A-122, and 431:10A-116.2,~~] and 431:10A- , and chapter 431M."

SECTION 5. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A- , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 4 of this Act, shall take effect for all policies, contracts, plans, or agreements issued in the State after December 31, 2015.

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	963
TWENTY-EIGHTH LEGISLATURE, 2015
STATE OF HAWAII