The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Banking and Insurance
BILL: CS/SB 498
INTRODUCER: Banking and Insurance Committee, Senator Baxley and Senator Perry
SUBJECT: Insurance Coverage for Hearing Aids for Children
DATE: January 18, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Johnson Knudson BI Fav/CS
2. Smith Brown HP Favorable
3. AP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 498 requires an individual health insurance policy or individual health maintenance
organization contract that provides major medical coverage or similar coverage for a dependent
child of an insured or subscriber, respectively, to provide hearing aid coverage for a covered
child from birth through age 18 who has been diagnosed with hearing loss by a licensed
physician or a licensed audiologist. The term, “hearing aid,” means any wearable instrument or
device designed for, offered for the purpose of, or represented as aiding persons with or
compensating for impaired hearing. The term does not include cochlear implants.
The bill requires the policies or contracts to provide a minimum coverage limit of $3,500 per ear
within a 24-month period. The insured or subscriber remains responsible for the cost of hearing
aids and related services that exceed the coverage limit provided for in the policy or contract. If,
however, a child experiences a significant and unexpected change in his or her hearing or
experiences a medical condition requiring an unexpected change in the hearing aid before the
existing 24-month period expires, and alterations to the existing hearing aid do not, or cannot,
meet the needs of the child, the bill requires that a new 24-month period must begin with full
benefits and coverage.
The bill applies to individual health insurance policies or contracts that are issued on or after
January 1, 2023 and the bill would take effect on that date. The provisions of the bill do not
apply to the State Group Insurance program; therefore, there is no fiscal impact to the program.
REVISED: BILL: CS/SB 498 Page 2
II. Present Situation:
One in eight people in the United States (13 percent, or 30 million) age 12 years or older has
hearing loss in both ears, based on standard hearing examinations.
1
Hearing loss is one of the
most common birth defects
2
in the United States, with approximately two or three out of every
1,000 children in the United States are born with a detectable level of hearing loss in one or both
ears.
3
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing
aid may help a child with hearing loss to make the most of their residual hearing.
4
Hearing aids
make sounds louder and can be worn by people of any age, including infants. Babies with
hearing loss may understand sounds better using hearing aids. There are many styles of hearing
aids. They can help many types of hearing loss. A young child is usually fitted with behind-the-
ear style hearing aids because they are better suited to growing ears.
5
Hearing loss may be in one ear (unilateral loss) or in both ears (bilateral loss). The degree of
hearing loss can range from mild to profound, as described below:
6
Mild Hearing Loss (26-40 decibels). A person with a mild hearing loss may hear some
speech sounds, but soft sounds are hard to hear.
Moderate Hearing Loss (41-70 decibels). A person with a moderate hearing loss may hear
almost no speech when another person is talking at a normal level.
Severe Hearing Loss (71-90 decibels). A person with severe hearing loss will hear no speech
when a person is talking at a normal level and only hear some loud sounds.
Profound Hearing Loss (91 decibels or more). A person with a profound hearing loss will not
hear any speech and will hear only very loud sounds.
7
Hearing loss can affect a child’s ability to develop communication, language, and social skills.
Early detection of hearing loss can help infants and children with learning and reaching
developmental milestones, according to recent research. In the United States, researchers have
reported that children have more favorable language outcomes, such as greater vocabulary and
reading abilities, when hearing loss is identified sooner and the child receives hearing aids and
1
See National Institutes for Health, National Institute on Deafness and Other Communication Disorders available at
https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing (last visited Jan. 14, 2022).
2
Florida Newborn Screening, Early Hearing and Intervention Program available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/ (last visited Jan. 14, 2022).
3
Id.
4
Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (Jun. 8, 2020)
available at https://www.cdc.gov/ncbddd/hearingloss/treatment.html (last visited Dec. 18, 2021). The amount of hearing a
deaf or hard-of-hearing person has is referred to as “residual hearing.”
5
Id. A plastic ear mold is connected to a behind-the-ear hearing aid and is fitted for the child’s ear. It directs sound from the
hearing aid into the ear canal. Each individual’s ear is shaped differently, and a child’s ear will change as he or she grows. An
audiologist uses a soft material to make a copy of the child’s outer ear canal. This is used to make an ear mold that will fit the
child. As the child grows, new ear molds can be made and attached to the same hearing aid.
6
Florida Department of Health and Children’s Medical Services, A Florida Parent’s Guide to Hearing (Apr. 2020 Edition)
available at http://floridanewbornscreening.com/wp-content/uploads/Hearing-Guide-English-FINAL-1.pdf (last visited Jan.
14, 2022).
7
See Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (Jun. 8,
2020), available at https://www.cdc.gov/ncbddd/hearingloss/types.html (last visited Jan. 14, 2022). BILL: CS/SB 498 Page 3
interventions at an earlier age.
8
A second study similarly found that children who received
hearing aids and cochlear implants earlier had better language outcomes, comparing language
skills with the provision of a hearing aid at three months compared to 24 months.
9
The authors’
state:
The younger the child received intervention, the better the language outcome. In addition,
more substantial benefits of earlier access to useful HAs (hearing aids) and CI (cochlear
implants) were obtained by those with worse hearing. Earlier intervening, rather than
access to UNHS (universal newborn hearing screening), improved outcomes.
10
Florida Newborn Hearing Screening Program
Florida has a universal newborn hearing-screening program
11
that requires all Florida-licensed
facilities that provide maternity and newborn care to screen, or refer for screening, all newborns
prior to discharge for hearing loss, unless a parent objects to the screening.
12
All test results,
including recommendations for any referrals or follow-up evaluations by a licensed audiologist,
a physician licensed under chs. 458 or 459, F.S., or other newborn hearing screening providers in
the hospital facility, must be placed in the newborn’s medical records within 24 hours after the
completion of the screening procedure.
13
For babies born in a facility other than a hospital, the
parents are to be instructed on the importance of having a screening conducted, information must
be provided, and assistance must be given to make an appointment within three months.
14
The initial newborn screening and any necessary follow-up and evaluation are covered benefits
reimbursable by Medicaid, health insurers, and health maintenance organizations, with some
limited exceptions.
15
For those newborns and children found to have a permanent hearing loss,
the law also provides for referral to the state’s Part C program of the federal Individuals with
Disabilities Education Act
16
and Children’s Medical Services’ Early Intervention Program, Early
Steps.
17
8
Christine Yoshinaga-Itano, Ph.D., et al, Early Hearing Detection and Vocabulary of Children with Hearing Loss,
PEDIATRICS, (Aug. 2017, Vol. 140, No. 2), available at https://pediatrics.aappublications.org/content/140/2/e20162964 (last
visited Jan. 14, 2022).
9
Teresa Y.C. Ching, Ph.D., Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes, Pediatrics,
(Sept. 2017, Vol. 140, Issue 3), available at https://pediatrics.aappublications.org/content/140/3/e20164274 (last visited Jan.
14, 2022).
10
Id.
11
Florida’s Early Hearing Detection and Intervention Program (EHDI) is Florida’s newborn hearing-screening program
available at https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/ (last visited Jan. 14,
2022).
12
See s. 383.145, F.S.
13
Section 383.145(3)(e), F.S.
14
Section 383.145(3)(i), F.S.
15
Section 383.145(3)(j), F.S.
16
See Pub. L. No. 108-446. The Part C program provides benefits and services for infants and toddlers from birth to age 36
months. Children’s Medical Services, within the Department of Health, administers Florida’s Part C program, which is
known as Early Steps.
17
The Early Steps program services children with disabilities, developmental delays, or children with a physical or mental
condition known to create a risk of a developmental delay. See http://www.cms-
kids.com/families/early_steps/early_steps.html (last visited Jan. 14, 2022). BILL: CS/SB 498 Page 4
Hearing Aid Coverage in Public Insurance Programs
Medicaid
Florida Medicaid provides hearing services for eligible recipients under the age of 21, if such
services are medically necessary to correct or ameliorate a defect, a condition, or a physical or
mental illness.
This coverage includes diagnostic services, treatment, equipment, supplies, and
other measures described in 42 U.S.C. 1396d(a).
18
Medicaid recipients under the age of 21 have
coverage for the following hearing related services:
Recipients who have documented, profound, severe hearing loss in one or both ears
have coverage for:
o An implanted device for recipients age five years and older; or
o A non-implanted (softband) device for recipients under age five.
Cochlear implants for recipients age 12 months and older who have documented,
profound to severe, bilateral sensorineural hearing loss.
For recipients who have moderate hearing loss or greater, the coverage is:
o One new, complete, (not refurbished) hearing aid device per ear, every three
years, per recipient;
o Up to three pairs of ear molds per year, per recipient; and
o One fitting and dispensing service per ear, every three years, per recipient.
A recipient under the age of 12 months may receive up to two newborn screenings. A
second screening may be conducted only if the recipient did not pass the test in one or
both ears.
An eligible recipient may receive one hearing assessment every 3 years for the
purposes of determining hearing aid candidacy and the most appropriate hearing aid.
19
Medicaid also covers repairs and replacement of both Medicaid and non-Medicaid provided
hearing aids, up to two hearing aid repairs every 366 days, after the one-year warranty period
has expired.
20
State Children’s Health Insurance Program
21
The Children’s Health Insurance Program (CHIP) was enacted as part of the Balanced Budget
Act of 1997, and it created Title XXI of the federal Social Security Act as a joint state-federal
funding partnership to provide health insurance to children in low to moderate income
households.
22
The Florida Healthy Kids Corporation
23
is one component of Florida’s Title XXI
program, known as Florida KidCare, and is the only program component utilizing a
18
See Fla. Admin. Code R. 54G-4.110 (2021). The hearing services coverage policy from the Agency for Health Care
Administration available at https://www.flrules.org/Gateway/reference.asp?No=Ref-06744 (last visited Jan. 14, 2022).
19
See Agency for Health Care Administration, Hearing Services Coverage Policy (June 2016), available at
http://ahca.myflorida.com/medicaid/review/specific_policy.shtml (last visited Jan. 14, 2022).
20
Id.
21
42 U.S.C. s. 1397aa-1397mm.
22
Pub. L. No. 105-33, 111 Stat. 251 (1997).
23
See ss. 624.91-624.915, F.S. BILL: CS/SB 498 Page 5
non-Medicaid benefit package.
24
The other program components, Medicaid for children,
Medikids, and Children’s Medical Services Network, follow the Medicaid benefit package.
25
In order for health benefits coverage to qualify for premium assistance payments, KidCare
enrollees must receive hearing screenings as a covered, preventative health service.
26
Additionally, s. 409.815(2)(h), F.S., provides that the benefits for durable medical equipment
include within covered services equipment and devices that are medically indicated to assist in
the treatment of a medical condition, and specifically prescribed as medically necessary. Hearing
aids are covered only when medically indicated to assist in the treatment of a medical condition.
There are no out of pocket costs for the well-child hearing screening for subsidized Title XXI
eligible children.
27
Hearing Aid Coverage in the Private Health Insurance Market
The Office of Insurance Regulation (OIR) is responsible for the regulation of all activities of
insurers and other risk-bearing entities that do business in Florida.
28
Florida law does not require
health insurance policies or HMO contracts to provide coverage for hearing aids. According to
OIR, some of the plans offered by UnitedHealthcare (All Savers, Neighborhood Health, etc.)
cover hearing aids if recommended by a physician, and bone-anchored hearing aids are covered
with some restrictions. Molina and Health First cover implant type hearing aids, if medically
necessary.
29
Currently, 24 states appear to mandate health benefit plans to provide coverage for hearing aids
for children.
30
Coverage requirements range from authorizing coverage of a hearing aid every 24
months to every five years. Many states include caps on the amount the insurer must pay. These
caps range from $1,000 to $4,000.
31
State Mandated Health Insurance Coverage
Prior to 2012, OIR identified 18 state mandated benefits.
32
Subsequently, Florida has not enacted
any mandated benefits. Examples of benefits mandated under Florida law include:
Treatment for temporomandibular joint disorders;
Coverage for bone marrow transplants;
Coverage for certain cancer drugs;
24
See ss. 409.810-409.821, F.S.
25
See s. 409.815(2)(a), F.S., and s. 391.0315, F.S.
26
Section 409.815(2)(a), F.S.
27
Florida Healthy Kids Corporation, Medical Benefits available at https://www.healthykids.org/benefits/medical/ (last visited
Jan. 14, 2022).
28
The OIR is under the Financial Services Commission, which is composed of the Governor, the Attorney General, the Chief
Financial Officer, and the Commissioner of Agriculture, which serves as the agency head of the commission. Section
20.121(3), F.S.
29
Office of Insurance Regulation correspondence (Dec. 8, 2020) (on file with Senate Committee on Banking and Insurance).
30
See information gathered by the American Speech-Language-Hearing Association available at
https://www.asha.org/advocacy/state/issues/ha_reimbursement/ (last visited Jan. 14, 2022).
31
Id.
32
Centers for Medicare & Medicaid Services, Florida – State Required Benefits, available at
https://downloads.cms.gov/cciio/State%20Required%20Benefits_FL.pdf (last visited Jan. 14, 2022). BILL: CS/SB 498 Page 6
Diabetes treatment services;
Osteoporosis;
Certain coverage for newborn children;
Child health supervision services; and
Treatment of cleft lip and cleft palate in children.
33
Section 624.215, F.S., requires every person or organization seeking consideration of a
legislative proposal, which would mandate a health coverage or the offering of a health coverage
by an insurer, to submit to the Agency for Health Care Administration and the legislative
committees having jurisdiction, a report that assesses the social and financial impacts of the
proposed coverage. Proponents submitted a report to Senate Banking and Insurance Committee
staff in 2021 that indicates there are less than 7,200 children under the age of 18 in Florida are
deaf.
34
Hearing aids and the services necessary to prescribe, evaluate, fit, and manage children
with hearing loss generally cost an average of $3,500 per ear depending on the technology and
enhancements selected by the audiologist based on the individual needs of the child.
35
(See
Section V, Fiscal Impact Statement, Private Sector Impact of the Bill Analysis.)
Advocates of the bill note that untreated hearing loss may lead to tremendous expense for the
taxpayer, as described below:
Untreated pediatric hearing loss costs $420,000 in special education costs per child
and $1 million over the lifetime of the individual.
Longitudinal, peer-reviewed studies have shown that healthcare costs are significantly
higher for individuals with untreated vs treated hearing loss.
Increased costs are not confined to the medical bills in the studies. Medical providers
must absorb (and pass on via increased overall costs) costs incurred from longer visit
times due to communication difficulties, increased risk of malpractice lawsuits from
communication difficulties, and necessary accommodations like interpreter services.
Communication difficulties in deaf and hard of hearing patients, which would be
mitigated by appropriate access to sound, result in more physician visits and overuse
of emergency rooms and urgent care centers.
Patients with untreated hearing loss are more likely to be misdiagnosed when visiting
providers for unrelated health issues and are more difficult to treat due to
communication difficulties.
36
Federal Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA)
37
does not require health insurance
policies to cover hearing aids for adults or for children. Under PPACA, individuals and small
33
Id.
34
Florida Coalition for Spoken Language Options, 2021 Florida Legislature, SB 1268 Mandate Report (on file with Senate
Committee on Banking and Insurance).
35
Id.
36
Id.
37
The PPACA (Pub. Law No. 111-148) was enacted on March 23. 2010. On March 30, 2010, PPACA was amended by Pub.
Law No. 111-152, the Health Care and Education Reconciliation Act of 2010. The two laws are collectively referred to as the
‘‘Patient Protection and Affordable Care Act’’ or ‘‘PPACA.’’ BILL: CS/SB 498 Page 7
businesses can obtain health insurance coverage on or off the federal marketplace exchanges.
38
All non-grandfathered health plans
39
must offer qualified health plans meeting certain federal
mandates, including the provisions of the following 10 essential health benefits (EHB):
Ambulatory services (outpatient care);
Emergency services;
Hospitalization (inpatient care);
Maternity and newborn care;
Mental health and substance abuse disorder services;
Prescription drugs;
Rehabilitative services and rehabilitative services and devices;
Laboratory services;
Preventive care and chronic disease management; and
Pediatric services, including oral and vision care.
40
States may modify the EHB offered in their states by mandating additional coverage. However,
states must defray the associated costs such benefits imposed on qualified health plans coverage,
and those costs should not be included in the percentage of premium attributable to the coverage
of EHB for calculating the premium tax credit for eligible enrollees
41
on the exchange.
42
The
State of Florida may be required to defray the costs of any additional benefits beyond the
required EHB put in place after 2011.
43
Reporting of Additional State-Required Benefits and Cost Analysis
For plan years beginning on or after January 1, 2020, each state must identify and report to the
federal Department of Health and Human Services (HHS) benefits mandated by state law and
identify which of those benefits are in addition to EHB. The first annual submission deadline for
states to notify the HHS of their state-mandated benefits was July 1, 2021.
44
Each qualified
38
Exchanges are entities established under PPACA through which qualified individuals and qualified employers can
purchase health insurance coverage in qualified health plans (QHPs). Many individuals who enroll in QHPs through
individual market exchanges are eligible to receive a premium tax credit (PTC) to reduce their costs for health insurance
premiums and to receive reductions in required cost-sharing payments to reduce out-of-pocket expenses for health care
services. 42 U.S.C. s. 18031.
39
A “grandfathered health plan” is a plan that maintains coverage that was in place prior to the passage of the PPACA or in
which the enrollee was enrolled on March 23, 2010, while complying with the consumer protection components of the
PPACA. If a group health plan enters a new policy, certificate, or contract of insurance, the group must provide the new
issuer the documentation from the prior plan so it can be determined whether there has been a change sufficient to lose
grandfather status. See s. 627.402, F.S.
40
42 U.S.C. s. 18022(b)(1)(A)-(J).
41
In Florida, 1,705,902 or 95 percent of the total marketplace exchange enrollees receive premium tax credits. KFF,
Marketplace Effectuated Enrollment and Financial Assistance (2020) available at https://www.kff.org/other/state-
indicator/effectuated-marketplace-enrollment-and-financial-
assistance/?currentTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-
states%22:%7B%7D%7D,%22states%22:%7B%22florida%22:%7B%7D%7D%7D &sortModel=%7B%22colId%22:%22Lo
cation%22,%22sort%22:%22asc%22%7D (last visited Jan. 14, 2022).
42
HealthCare.gov, Subsidized Coverage, available at https://www.healthcare.gov/glossary/subsidized-coverage/ (last visited
Jan. 14, 2022). Household income must be between 100 percent and 400 percent of the federal poverty level to qualify for a
premium tax credit.
43
See 42 U.S.C. s. 18031(d)(3)(B)(ii).
44
CFR 156.111. BILL: CS/SB 498 Page 8
health plan issuer in the state must quantify cost attributable to each additional required benefit
and then report this to the state.
45
In May 2020, HHS clarified existing rules to provide that it
would also be permissible for issuers to choose to rely on another entity, such as the state, to
produce the cost analysis, provided the issuer remains responsible for ensuring that the
quantification complies with existing rules.
46
Further, the HHS noted that this calculation should
be done prospectively to allow for the offset of an enrollee’s share of premium and for purposes
of calculating the PTC and reduced cost sharing.
47
Audiologist Scope of Practice and Licensure Requirements
An audiologist is licensed under part I of chapter 468, F.S., to practice audiology.
48
The practice
of audiology includes the application of principles, methods, and procedures for the prevention,
identification, evaluation, consultation, habilitation, rehabilitation, instruction, treatment, and
research, relative to hearing and the disorders of hearing, and to related language and speech
disorders.
49
A licensed audiologist may:
Offer, render, plan, direct, conduct, consult, or supervise services to individuals or
groups of individuals who have or are suspected of having disorders of hearing,
including prevention, identification, evaluation, treatment, consultation, habilitation,
rehabilitation, instruction, and research.
Participate in hearing conservation, evaluation of noise environment, and noise
control.
Conduct and interpret tests of vestibular function and nystagmus, electrophysiologic
auditory-evoked potentials, central auditory function, and calibration of measurement
equipment used for such purposes.
Habilitate and rehabilitate, including, but not limited to, hearing aid evaluation,
prescription, preparation, fitting and dispensing, assistive listening device selection
and orientation, auditory training, aural habilitation, aural rehabilitation, speech
conservation, and speechreading.
Fabricate ear molds.
Evaluate tinnitus.
Include speech and language screening, limited to a pass/fail determination for
identifying individuals with disorders of communication.
50
To become licensed as an audiologist, an applicant must:
Have earned a doctoral degree in audiology or have completed the academic
requirements of a doctoral degree program with a major emphasis on audiology at an
institution that meets specified requirements.
51
Receive a passing score on a national examination;
52
and
45
CFR 155.170(c).
46
85 Fed. Reg. 29218 (May 14, 2020).
47
Id.
48
Section 468.1125(1), F.S.
49
Section 468.1125(6)(a), F.S.
50
Section 468.1125(6)(b), F.S.
51
Section 468.1155(3)(b), F.S.
52
Section 468.1155(1)(a), F.S. BILL: CS/SB 498 Page 9
Demonstrate a minimum of 11 months of full-time professional employment or
practice with a provisional license.
53
An audiologist is required to perform a final fitting for a client to ensure the physical and
operational comfort of the hearing aid “when indicated.”
54
Hearing Aid Specialist Scope of Practice and Licensure Requirements
A hearing aid specialist is licensed under part II of chapter 484, F.S., to practice the dispensing
of hearing aids.
55
To become a hearing aid specialist, an applicant must:
Be a graduate from an accredited high school or its equivalent;
Have completed a training program as established by the Board of Hearing Aid
Specialists that is a minimum of six months in length, or be licensed or certified and
have been actively practicing for at least 12 months as a licensed in another state; and
Pass an examination as established by the Board of Hearing Aid Specialists.
56
A hearing aid specialist is required to perform a final fitting for all clients to ensure the physical
and operational comfort of the hearing aid.
57
III. Effect of Proposed Changes:
Sections 1 and 2 create ss. 627.6413 and 641.31(48), F.S., respectively, to require an individual
health insurance policy or individual HMO contract that provides major medical or similar
coverage for a dependent child, age 18 or younger, of the insured or subscriber to provide
coverage for a hearing aid prescribed, fitted, and dispensed by a physician licensed under ch. 458
or 459, F.S., or an audiologist licensed under part I of ch. 468, F.S. Such policies are required to
provide a minimum coverage of $3,500 per ear within a 24-month period.
The term, “hearing aid,” is defined as “any wearable instrument or device designed for, offered
for the purpose of, or represented as aiding persons with or compensating for, impaired hearing.”
The term does not include cochlear implants.
The bill provides that the insured or subscriber remains responsible for the cost of hearing aids
and related services that exceed the coverage limit provided for in the policy or contract.
However, if a child experiences a significant and unexpected change in his or her hearing or
experiences a medical condition requiring an unexpected change in the hearing aid before the
existing 24-month period expires, and alterations to the existing hearing aid do not or cannot
meet the needs of the child, the bill requires that a new 24-month period must begin with full
benefits and coverage.
The bill applies to policies or contracts that are issued or renewed on or after January 1, 2023.
53
Id.
54
Section 468.1225(3), F.S.
55
Section 484.041, F.S.
56
Section 484.045, F.S.
57
Section 484.0501(3), F.S. BILL: CS/SB 498 Page 10
Section 3. The bill provides an effective date of January 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
In 2021, advocates of the Florida Coalition for Spoken Language Options provided the
following analysis of the fiscal impact of SB 1268 on individual policies or contracts.
58
Like SB 1268, CS/SB 498 provides coverage up to age 18. According to the Florida
Coalition for Spoken Language Options, approximately 461 children will benefit from
the mandated coverage, and the resulting increases in costs are estimated to be $0.74
annually or .06 monthly per covered life, as described below:
58
Florida Coalition for Spoken Language Options, SB 1268 Mandate Report (on file with Senate Committee on Banking and
Insurance).
59
Office of Insurance Regulation correspondence (Dec. 8, 2020) (on file with Senate Committee on Banking and Insurance).
Florida Population/Demographics 21,477,737
Florida Population Under 0-18 (19.7%) 4,231,114
All Floridians with individual major
medical plans
59
1,765,807
19.7% of all covered lives on individual
major medical plans are under 18
347,864
0.17% of children have hearing loss 7,193 BILL: CS/SB 498 Page 11
C. Government Sector Impact:
None. The bill’s requirements do not apply to the State Group Insurance Program since
the bill does not mandate that group or employer coverage provide the benefits.
VI. Technical Deficiencies:
The bill does not define “significant and unexpected change” in hearing requiring an unexpected
change in the prescription or what criteria will be used to make that determination. Defining this
term in the bill or through rulemaking should reduce disputes over whether a change in hearing is
“significant and unexpected.”
60
VII. Related Issues:
Generally, insurance policies and HMO contracts are issued with a one-year duration. It may be
difficult to implement a coverage requirement that lasts for 24 months, as proposed in the bill.
61
60
Office of Insurance Regulation, 2021 Legislative Session, Senate Bill 1268 Fiscal Analysis (Feb. 18, 2021) (on file with
Senate Committee on Banking and Insurance).
61
Id.
0.17% of the children who have
individual major medical plans
591
2% of .17% slight loss/no hearing aid
needed
-12
30% of .17% severe to profound
sensorineural or mixed loss/ cochlear
implant candidate
-177
.17% of 16,170 Children Receiving Early
Steps
-11
Impacted Hearing Aid Candidates 461
39% unilateral 180
61% bilateral 281
Total Cost per Unilateral ($3500 per ear
over 24 months)
$630,000
Total Cost Per Bilateral ($3500 per ear
over 24 months)
$1,967,000
Total Cost Over 24 Months $2,597,000
Cost per Year $1,298,500
Annual Cost per Plan ($1,298,500 spread
over 1,765,807 covered lives) $0.74
Cost Per Month Per Covered Life $0.06 BILL: CS/SB 498 Page 12
VIII. Statutes Affected:
This bill substantially amends section 641.31 of the Florida Statutes.
This bill creates section 627.6413 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Banking and Insurance on January 12, 2022:
The committee substitute:
Requires individual market health insurance policies and HMO contracts providing
major medical or similar comprehensive coverage to provide coverage for hearing
aids for children through age 18 rather than age 21.
Revises the definition of the term “hearing aid” to exclude cochlear implants.
Clarifies that a physician licensed under ch. 458 or 459, F.S., or an audiologist
licensed under ch. 468, F.S., must make the diagnosis of a hearing loss.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.