AB 16

This bill requires health insurance policies and plans to cover the cost of

hearing aids, which include any externally wearable instruments or devices

designed to enhance hearing, and cochlear implants, which include any implantable

instruments or devices designed to enhance hearing, that are prescribed by a

physician or audiologist in accordance with accepted professional medical or

audiological standards, for any child under 18 years of age who has coverage under

the policy or plan and who is certified as deaf or hearing impaired by a physician or

an audiologist. Treatment (defined as services, diagnoses, procedures, surgery, and

therapy provided by a health care professional) that is related to the hearing aids and

cochlear implants is also required to be covered. Coverage for hearing aids and

related treatment is not required to exceed the cost of one hearing aid and related

treatment per ear per child more often than once every three years. The coverage

requirement applies to both individual and group health insurance policies and

plans, including defined network plans and cooperative sickness care associations;

to health care plans offered by the state to its employees, including a self-insured

plan; and to self-insured health plans of counties, cities, towns, villages, and school

districts. The requirement specifically does not apply to limited-scope benefit plans,

medicare replacement or supplement policies, long-term care policies, or policies

covering only certain specified diseases. The required coverage may be subject to any

limitations, cost-sharing provisions, or exclusions, other than a preexisting

condition exclusion, that apply generally under the policy or plan. An exception is

that an individual health insurance policy may impose a preexisting condition

exclusion that does not exceed one year with respect to coverage for cochlear

implants and related treatment. However, the bill requires an individual health

insurance policy that imposes a preexisting condition exclusion to cover the cost of

cochlear implants and related treatment during the preexisting condition exclusion

period if certain specified medical conditions occur during the period that make time

of the essence for a child to receive the implants and related treatment.

Under the bill, if an insurer denies coverage to a child under an individual

health insurance policy and the child would be eligible for hearing aid and cochlear

implant benefits, the insurer must advise the child's family of the availability of

coverage for hearing aids and cochlear implants and related treatment under

BadgerCare Plus, which is a Medical Assistance program that provides health care

benefits and under which any child in the state is eligible to receive or purchase

coverage.