Hearing Impairment Benefit Background
For individuals with hearing impairments, hearing aids (including batteries, repairs, and maintenance needed to operate them) are generally subject to group health plans’ deductibles and other cost-sharing requirements, but considered a qualifying medical expense[2] under Internal Revenue Code (IRC) Section 213(d) for purposes of reimbursement by a health flexible spending arrangement (FSA), or health reimbursement arrangement (HRA), or for a tax-free distribution from a Health Savings Account (HSA).
As a reminder, hearing screenings for all newborn children and regular hearing screenings for children and adolescents (as recommended by their providers) are generally covered without cost-sharing requirements as preventive care benefits for children under the Affordable Care Act.
Ohio H.B. 315
Hearing Aid Coverage for Children
H.B. 315 (Section 3902.64) requires fully insured group health plans issued in Ohio to cover hearing aids and related services for covered children up to age 21.
The requirements of this new childhood hearing aid benefit in Ohio are summarized below:
- Coverage of one hearing aid per hearing-impaired ear, up to $2,500 for plan participants up to age 21 every four years (or 48 months).
Hearing aid is defined under H.B. 315 as “any wearable instrument or device designed or offered for the purpose of aiding or compensating for impaired human hearing, including all attachments, accessories, and parts thereof, except batteries and cords, that is dispensed by a licensed audiologist, a licensed hearing aid dealer or fitter, or an otolaryngologist.”
- Coverage of “related services” prescribed by an otolaryngologist or recommended by a licensed audiologist and dispensed by a licensed audiologist, a licensed hearing aid dealer or fitter.
"Related services" is defined under H.B. 315 as “services necessary to assess, select, and appropriately adjust or fit a hearing aid to ensure optimal performance.”
- Eligible plan participants must be verified as deaf or hearing impaired by a licensed audiologist, otolaryngologist, or other licensed physician.
- Coverage for hearing aids must be considered medically appropriate to meet the needs of the plan participant, in accordance with professional standards established by the state speech and hearing professionals board.
- Coverage is not required if the plan participant received hearing aid coverage from another plan within four years (or 48 months) prior to the date of claim.
- Eligible plan participants may choose a hearing aid priced higher than the $2,500 coverage limit and pay the difference without any financial or contractual penalty.
This specific provision (as currently written) presumably does not subject this new hearing aid benefit for children to a deductible or cost-sharing requirement. As such, this provision currently appears problematic for purposes of HSA-qualifying high-deductible health plans (HDHPs). As a reminder, IRC Section 223(c)(2)(C) requires HSA-qualifying HDHPs participants to satisfy their deductible before receiving most non-preventive services coverage, including expenses for hearing aids.
Risk Strategies will monitor for any state updates to this provision of law to resolve this HDHP issue. In the meantime, employer plan sponsors are encouraged to reach out to their group health plan insurance carriers for more guidance and direction here.
Cost-Sharing Parity for Certain Therapy Services
Additionally, H.B. 315 (Section 3902.63) requires that cost-sharing, including copayments, for the following therapy services must be the same (or less than) primary care office visit services:
- occupational therapy services,
- physical therapy services, and
- chiropractic services.
Health plan insurance carriers are required to clearly state on their websites and on all applicable plan materials that these therapy services are available under the plans, along with related limitations, conditions (including this new cost-sharing parity requirement), and exclusions.
Self-Funded Plans: H.B. 315 does not apply to self-funded ERISA group health plans, including level-funded ERISA group health plans.
Employer Plan Sponsor Considerations
Employers sponsoring fully insured group health plans issued in Ohio should be aware of these new coverage requirements under H.B. 315, now in effect as of April 3, 2025. They are also advised to liaise with their applicable health plan insurance carriers to receive updated guidance and plan materials, including an updated Summary of Benefits and Coverage (SBC), to communicate to their plan participants.
These coverage changes under H.B. 315 are not anticipated to significantly increase plan rates, but employer plan sponsors are encouraged to obtain confirmation as such from their insurance carriers.
Contact your Risk Strategies account team with any questions or contact us directly here.
[1] Madeline’s Law is “named in honor of a young Ohio resident whose personal experience highlighted the financial struggles families face when hearing aids are not covered by insurance.”
[2] https://www.irs.gov/publications/p502
