Hearing Aid Legislation SB 57

Note: This information is provided for informational purposes only and does not constitute legal advice.

During the 2008 legislation session, SB 57 was enacted to require insurance coverage for hearing aids for children. This document is published by Colorado Families for Hands & Voices to assist parents throughout the state in the implementation of the law.

Are all insurance companies subject to this law?

There are three types of insurance coverage:  Public, Private and self-insured:

Public (Medicaid and CHP+) The new statute applies only to private insurance. Medicaid is not subject to this statute. However, because CHP+ is administered as insurance coverage, children covered under the CHP+ program will be subject to the requirement.

Private Insurance Co.  SB 57 mandates that these Insurance companies provide Hearing Aid coverage for children (i.e.  Pacificare, Anthem, Kaiser Permanente, Great Western)

Self Insured: Some companies ‘self-insure’ their employees. This means that the company pays for all expenses out of the company, even if they use an insurance company to process the claims. The Employee Retirement Income Security Act (ERISA) is a federal law which allows self-insured companies to determine which benefits they will pay, regardless of what state law requires. Self-insured plans are often referred to as ERISA plans.  These plans are not subject to regulation by the Division of Insurance like private insurance and therefore will not be required by state law to provide coverage for hearing aids.  In the coming months, insurance companies will be required to issue an identification card to all their covered individuals, and this card will have an identifier on it if the policy is subject to regulation by the Division of Insurance. This will probably take the form of the initials “DOI” on the card.

When is the effective date of SB 57?

The law states:  “This act shall take effect January 1, 2009, and shall apply to policies issued or renewed on or after said date.”

SB 57 goes into effect on January 1, 2009, and applies to all insurance policies which are issued or renewed after that date. In effect, this means that during 2009, coverage must become effective as policies are renewed through the year. Many policies are renewed on January 1, others renew on other dates, such as April 1, July 1, or even later in the year. Coverage will not be in effect until after the renewal date. You may need to contact the insurance company to verify the specific date on which coverage will be effective. Following this initial year, coverage will be continuous under the policies. Additionally, your provider will need to verify eligibility with your plan, prior to ordering and fitting the amplification.

Who do I need to go to access this benefit?

You need to go to a physician and audiologist to get cleared for amplification through your network of providers in your insurance policy.

What services/devices are covered?

The statute requires coverage of hearing aids which are:

• Medically appropriate to meet the needs of the child according to accepted professional standards.” (As of this writing, the Commissioner of Insurance has not yet promulgated regulations to govern this coverage. The hearing is expected to be in November.)
• This coverage is subject to the same deductibles and co-pay requirements as other covered items. The Commissioner of Insurance may provide additional guidelines in the rules and regulations to be issued in November.

How often can the hearing aid be replaced?

The statute requires coverage of the initial hearing aids and replacement hearing aids not more frequently than every 5 years. Coverage must also be provided for a new hearing aid if the existing hearing aid cannot be repaired or changed to meet the needs of the child, for example, the hearing level of the child changes such that the existing hearing aid cannot be adjusted adequately. Coverage must also cover services and supplies, earmolds, including the initial assessment, fitting, adjustments, and auditory training.

Questions to clarify with your insurer:

1. Am I limited to specific providers?
2. What co-pay applies for this benefit? Note: The benefits accorded pursuant to this subsection shall be subject to the same annual deductible or copayment established for all other covered benefits within the insured’s policy and utilization review as provided in sections 10-16-112, 10-16-113.5
3. How do I submit a claim for this benefit?

What can I do if this law does not apply to me?  (you have a self-insured policy)

Contact your employer and let them know about this law and that your child needs coverage. Generally speaking, self-insured policies typically follow suit with the other insurance companies over time. If you would like to be part of a list of parents who are under the ‘self-insured’ policy, please contact us at Colorado Hands & Voices: info@co-hv.org
We will work with you to see how a combined advocacy effort could be used to make changes to self-insured policies. Many families have already made changes with their employers!