Summary: Ohio Governor Mike DeWine recently signed omnibus legislation (House Bill or H.B. 315) on January 2, 2025, requiring fully insured health insurance plans issued in Ohio to cover hearing aids for children up to age 21, beginning April 3, 2025. The hearing aid coverage portion of H.B. 315 is named “Madeline’s Law.”[1] Ohio now joins the ranks of 25 other states requiring health plans issued in those states to provide coverage of hearing aid expenses for children.
H.B. 315 also requires cost-sharing parity under fully insured group health plans issued in Ohio between certain therapy services and primary care office visit services.
Read on for more information and employer plan sponsor considerations.
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.
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:
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.”
"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.”
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:
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.
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