SB 331: Health care coverage: hearing aids.

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, 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 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.