BILL NUMBER: SB 1158	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Scott

                        JANUARY 29, 2004

   An act to add Section 1367.195 to the Health and Safety Code, and
to add Section 10123.75 to the Insurance Code, relating to health
care.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1158, as introduced, Scott.  Hearing aids.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care.  Existing law requires a health
care service plan to provide specified coverage to its enrollees and
subscribers.  Existing law provides that a violation of the act is a
crime.
   Existing law provides for the regulation of health insurers by the
Insurance Commissioner.  Existing law requires a health insurance
policy to provide specified coverage to insureds.
   This bill would require health care service plans and health
insurers to provide coverage up to $1,000 for hearing aids, as
defined, to all enrollees, subscribers, and insureds under 18 years
of age.  The bill would provide that the coverage would not apply to
certain types of insurance.
   Because this bill would place additional requirements on health
care service plans, the violation of which is 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.
   Vote:  majority.  Appropriation:  no.  Fiscal committee:  yes.
State-mandated local program:  yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1367.195 is added to the Health and Safety
Code, to read:
   1367.195.  (a) Every health care service plan contract that covers
hospital, medical, or surgical expenses on a group basis, that is
issued, amended, or renewed on or after January 1, 2005, shall
provide coverage for hearing aids, up to one thousand dollars
($1,000), to all enrollees and subscribers under 18 years of age.
This benefit may be restricted to one claim during a 36-month period.

   (b) For purposes of this section "hearing aid" means any
nonexperimental, wearable instrument or device designed for the ear
and offered for the purpose of aiding or compensating for impaired
human hearing, but excluding batteries and cords.
   (c) It shall remain within the sole discretion of the health care
service plan as to the provider of hearing aids with which it chooses
to contract.  Reimbursement shall be provided according to the
respective principles and policies of the health care service plan.
Nothing contained in this section shall preclude a health care
service plan from conducting managed care, medical necessity, or
utilization review.
  SEC. 2.  Section 10123.75 is added to the Insurance Code, to read:

   10123.75.  (a) Every policy of health insurance that covers
hospital, medical, or surgical expenses, that is issued, amended, or
renewed on or after January 1, 2005, shall provide coverage for
hearing aids, up to one thousand dollars ($1,000), to all insureds
under 18 years of age.  This benefit may be restricted to one claim
during a 36-month period.
   (b) For purposes of this section "hearing aid" means any
nonexperimental, wearable instrument or device designed for the ear
and offered for the purpose of aiding or compensating for impaired
human hearing, but excluding batteries and cords.
   (c) It shall remain within the sole discretion of the health
insurer as to the provider of hearing aids with which it chooses to
contract. Reimbursement shall be provided according to the respective
principles and policies of the health insurer.  Nothing contained in
this section shall preclude a health insurer from conducting managed
care, medical necessity, or utilization review.
   (d) This section shall not apply to Medicare supplement,
vision-only, dental-only, Champus-supplement insurance, or to
insurance excluded from the definition of health insurance pursuant
to subdivision (b) of Section 106.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B 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 XIII B of the California
Constitution.