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CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

93

Introduced by Senator Menjivar

(Coauthors: Senators Becker, Dahle, and Niello)

February 12, 2025

An act to add Section 1367.72 to the Health and Safety Code, and to add Section 10123.72 to the Insurance Code, relating to health care coverage.

Vote: majority   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy to include, at a minimum, coverage for essential health benefits, as specified. Commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, existing law requires essential health benefits to include an annual hearing exam and one hearing aid per ear every three years.

This bill, the Let California Kids Hear Act, would require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, 2028, to include coverage for hearing aids, as defined, and related services for enrollees and insureds under 21 years of age, if medically necessary. The bill would limit the maximum required coverage amount to $3,000 per individual hearing aid, authorize a large group health care service plan contract or health insurance policy to limit the dollar coverage for each individual hearing aid device to $3,000, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:

SECTION 1.

This act shall be known, and may be cited, as the Let California Kids Hear Act.

SEC. 2.

Section 1367.72 is added to the Health and Safety Code, to read:

1367.72.

(a) A large group health care service plan contract issued, amended, or renewed on or after January 1, 2027, 2028, shall include coverage for hearing aids and related services for enrollees under 21 years of age, if medically necessary. The covered service shall be provided by a contracted provider, unless the contract allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist. The large group health care service plan contract shall cover services provided by a qualified audiologist with experience with children when medically necessary, consistent with this chapter.

(b) (1) The maximum required coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. A large group health care service plan contract may limit the dollar coverage for each individual hearing aid device to three thousand dollars ($3,000). An enrollee may choose to purchase a hearing aid that exceeds the maximum coverage amount this limit and shall be responsible for the difference between the cost of the hearing aid and the maximum coverage amount. this limit.

(2) Hearing aids covered pursuant to this section shall not be subject to a deductible, coinsurance, or copayment requirement. deductible, and coinsurance shall be capped at 10 percent. Coverage of hearing aids under this section shall not be subject to any other financial or treatment limitations, including a dollar limit that is set below three thousand dollars ($3,000) per individual hearing aid. except as authorized under this section. This section shall not be construed to prohibit a large group health care service plan from requiring use of a network provider consistent with the terms and conditions of the large group health care service plan contract and this chapter.

(3) If a contract is a “high deductible health plan” under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose cost sharing except as described in paragraph (2), unless not applying cost sharing would conflict with federal requirements for high deductible health plans.

(4) Coverage for hearing aids shall include an initial assessment, new hearing aids at least once every three years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the enrollee, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. The new hearing aid limit does not apply if alterations to existing hearing aids cannot meet the needs of the enrollee or an existing hearing aid is no longer working. includes all of the following:

(c) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.

(d) (1) This section does not apply to a Medicare supplement policy or specialized health care service plan contract that covers only dental or vision benefits. contract.

(2) This section does not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, and Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code. For these plans, the Medi-Cal requirements imposed pursuant to subdivision (l) of Section 14132 of the Welfare and Institutions Code apply.

SEC. 3.

Section 10123.72 is added to the Insurance Code, to read:

10123.72.

(a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2027, 2028, shall include coverage for hearing aids and related services for all insureds under 21 years of age, if medically necessary. The covered service shall be provided by a contracted provider, unless the policy allows for out-of-network coverage. For children under five years of age, a contracted provider shall include a pediatric audiologist. Health insurers shall cover services provided by a qualified audiologist with experience with children when medically necessary, consistent with this chapter.

(b) (1) The maximum required coverage amount under this section is three thousand dollars ($3,000) per individual hearing aid. A large group health insurance policy may limit the dollar coverage for each individual hearing aid device to three thousand dollars ($3,000). An insured may choose to purchase a hearing aid that exceeds the maximum coverage amount this limit and shall be responsible for the difference between the cost of the hearing aid and the maximum coverage amount. this limit.

(2) Hearing aids covered pursuant to this section shall not be subject to a deductible, coinsurance, or copayment requirement. deductible, and coinsurance shall be capped at 10 percent. Coverage of hearing aids under this section shall not be subject to any other financial or treatment limitations, including a dollar limit that is set below three thousand dollars ($3,000) per individual hearing aid. except as authorized under this section. This section shall not be construed to prohibit a health insurer from requiring use of a network provider consistent with the terms and conditions of the policy and this chapter.

(3) If a health insurance policy is a “high deductible health plan” under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose cost sharing except as described in paragraph (2), unless not applying cost sharing would conflict with federal requirements for high deductible health plans.

(4) Coverage for hearing aids shall include an initial assessment, new hearing aids at least once every three years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the insured, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. The new hearing aid limit does not apply if alterations to existing hearing aids cannot meet the needs of the insured or an existing hearing aid is no longer working. includes all of the following:

(c) For purposes of this section, “hearing aid” means an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. This includes both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.

(d) (1)This section does not apply to a specialized health insurance policy that covers only dental or vision benefits or a Medicare supplemental or a Medicare supplemental policy.

SEC. 4.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.