Children's Hearing Aid Law Effective January 1, 2013

The Hearing Aid Law for Children, Chapter 233 of the Acts of 2012, went into effect in Massachusetts on January 1, 2013. Following are some of the most commonly asked questions about the new law.

Please note: This page is provided by MassHAFCC for informational purposes only and does not constitute legal advice.

UPDATE: On December 31, 2012, the Division of Insurance issued a bulletin to clarify certain parts of this law. Click here to read the bulletin. Relevant parts of the bulletin are also inlcuded in the answers, below.

FREQUENTLY ASKED QUESTIONS

What does the law provide?Chapter 233 provides insurance coverage for hearing aids for children 21 years old and younger up to $2,000 per hearing aid for each hearing impaired ear in each 36-month period.

When is the effective date of the law?The law applies to all health plans that are delivered, issued or renewed on or after January 1, 2013. This means that coverage becomes effective as policies are renewed throughout 2013. Following this year, coverage will remain continuous under health insurance policies. Before you begin the process of purchasing hearing aids, check with your health insurance carrier to verify the specific date on which your coverage will be effective.

Example: Your health insurance plan renews on July 1^st. Coverage becomes effective under your policy on July 1^st. This means that you may not purchase hearing aids for your child or seek coverage for related services and supplies under this law until July 1^st.

What does the $2,000 cap include?The $2,000 cap includes coverage for each hearing aid device. An insured may select a higher-priced hearing aid and pay the difference in cost above the $2,000 limit for the device. Plans must also cover all services related to a covered hearing aid device, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. These amounts are not included in the $2,000 coverage limit that applies to the hearing aid device, but are covered separately and outright under your plan.

Are batteries covered? Yes. Coverage under this law includes related services, including the initial hearing aid evaluation, hearing aid fittings and adjustments and supplies. Batteries are covered under the "supplies" section of the law. A billing code already exists for hearing aid batteries- your dispensing audiologist should have this.

How about ear molds? Ear molds are covered under this law.

Who is covered?Children 21 years of age or younger who are covered under fully-insured plans.

Who is not covered?Children who are covered under self-insured plans are not covered by this law. A self-insured (or self-funded) plan is one in which the employer assumes the financial risk for providing health care benefits to its employees, even if an insurance company is used to process the claims. Self-insured plans are governed by federal ERISA laws and are not subject to state mandates or regulation by the state Division of Insurance. This means that self-insured employers will not be required to provide hearing aid coverage under Chapter 233.

How do I know if my plan is fully-insured?You may find out if your plan is fully-insured by contacting your insurance carrier or your Human Resources department at your place of employment.

What do I do if I find out that my plan is self-insured?You may advocate for your child! Contact your employer to explain why they should add this coverage to their insurance plan. Often employers will follow state mandates by adding similar coverage. One reason employers decide to self-insure is so that they may customize a plan to meet the specific needs of their workforce. If an employee is in need of specific coverage, an employer may consider adding the benefit. The final decision rests with your employer.

What if my plan has a high deductible?Chapter 233 allows carriers to apply deductibles, coinsurance, co-payments or out-of-pocket limits to hearing aid devices, supplies and services related to hearing aids, but they may not be greater than any applied to other benefits covered in the health plan. If you have a high deductible that would effectively cancel out the benefit afforded by this law, you may wish to shop around for another health insurance carrier. If this is not possible, consider appealing to your health insurance carrier to provide the coverage. Every health insurance carrier has a dispute resolution process and must consider your appeal.

Must I live in Massachusetts to be covered under this law?Not necessarily. If you work for an employer that is located in Massachusetts but reside outside of Massachusetts, you are most likely eligible for benefits under Chapter 233. To be sure, check with your Human Resources department.

What if I live in Massachusetts but work for an out-of-state employer?If your employer is located outside Massachusetts, you are most likely ineligible for benefits under Chapter 233 because your employer would be subject to insurance mandates and oversight by the state in which it is located. To be sure, check with your Human Resources department.

What do I do once I find out that my child is eligible to purchase hearing aids under this law?Once you determine that your child is covered by a fully-funded plan and are certain of your renewal date, you will need a written statement from your child’s treating physician that the hearing aids are necessary. Either your child’s pediatrician or ENT may provide this written statement. Then, your child’s audiologist will recommend a hearing aid that best fits your child.

Can my child be denied hearing aids depending on how the hearing loss occurred?No. Chapter 233 provides that a child must be afforded coverage for hearing aids if a treating physician or ENT issues a written statement that the hearing aids are necessary regardless of how the hearing loss occurred (e.g., at birth, late onset, accident, illness).

Is this law based on income levels?No. Any child 21 years of age or younger who resides in Massachusetts, is covered by a fully-insured health plan and meets the other requirements listed in the law is eligible to receive the benefit.

Is there anything that I need to know about talking to my health insurance company?Always get the full name, phone number and extension of the insurance representative with whom you speak in the event that you or someone else will need to follow up on the conversation. Take notes during your discussions and keep the notes in a file or notebook so that you may refer to them again, if necessary.

What if I am eligible for coverage under this law but my insurance company denies or delays coverage?If you are denied coverage or coverage is unduly delayed by your insurance company, you may file an appeal or grievance with your insurance company or you may contact the Bureau of Managed Care at the Division of Insurance in Boston to file a complaint by phone, fax or e-mail. You may also contact the Office of Patient Protection at the Department of Public Health in Boston.

Bureau of Managed Care
Division of Insurance
Office of Consumer Affairs and Business Regulations
1000 Washington Street, Suite 810
Boston, MA 02118
Tel: (617) 521-7372
Fax: (617) 521-7773 www.mass.gov/doi/
E-mail: bmc.mailbox@state.ma.us

Office of Patient Protection
Department of Public Health
250 Washington Street, 2nd Floor
Boston, MA 02108
Toll Free: 1-800-436-7757 (within Mass. only)
Fax: (617) 624-5046 www.mass.gov/dph/opp

Universal Newborn Hearing Screening Program
Department of Public Health
250 Washington Street, 5th Floor
Boston, MA 02108
Tel: 1-800-882-1435