ORS 743A.141
Hearing aids and hearing assistive technology systems


(1)

As used in this section:

(a)

“Hearing aid” means any nondisposable, wearable instrument or device designed to aid or compensate for impaired human hearing and any necessary ear mold, part, attachments or accessory for the instrument or device, except batteries and cords.

(b)

“Hearing assistive technology systems” means devices used with or without hearing aids or cochlear implants to improve the ability of a user with hearing loss to hear in various listening situations, such as being located a distance from a speaker, in an environment with competing background noise or in a room with poor acoustics or reverberation.

(2)

A health benefit plan, as defined in ORS 743B.005 (Definitions), shall provide payment, coverage or reimbursement for:

(a)

One hearing aid per hearing impaired ear if:

(A)

Prescribed, fitted and dispensed by a licensed audiologist with the approval of a licensed physician; and

(B)

Medically necessary for the treatment of hearing loss in an enrollee in the plan who is:
(i)
18 years of age or younger; or
(ii)
19 to 25 years of age and enrolled in a secondary school or an accredited educational institution.

(b)

Ear molds and replacement ear molds:

(A)

Up to four times per plan year for enrollees who are younger than eight years of age; and

(B)

At least once per year for enrollees who are:
(i)
Eight to 18 years of age; or
(ii)
19 to 25 years of age and enrolled in a secondary school or an accredited educational institution.

(c)

One box of replacement batteries per year for each hearing aid.

(d)

Necessary diagnostic and treatment services at least twice per year for enrollees who are younger than four years of age and at least once per year for enrollees who are four years of age or older, including:

(A)

Hearing tests appropriate for an enrollee’s age or developmental need;

(B)

Hearing aid checks; and

(C)

Aided testing.

(e)

Bone conduction sound processors, if necessary for appropriate amplification of the hearing loss.

(f)

Hearing assistive technology systems for an enrollee who is younger than 19 years of age, if necessary for appropriate amplification of the hearing loss.

(3)

An insurer may not impose any financial or contractual penalty upon an audiologist if an enrollee elects to purchase a hearing aid or other device priced higher than the benefit amount by paying the difference between the benefit amount and the price of the hearing aid or other device.

(4)

A health benefit plan shall provide the benefits described in subsection (2)(a), (e) and (f) of this section:

(a)

Every 36 months; or

(b)

For hearing aids, more frequently than every 36 months if modifications to an existing hearing aid will not meet the needs of an enrollee who is:

(A)

Under 19 years of age; or

(B)

19 to 25 years of age and enrolled in a secondary school or an accredited educational institution.

(5)

An insurer must contract with pediatric audiologists in sufficient numbers and geographic locations in this state to comply with ORS 743B.202 (Requirements for insurers offering managed health or preferred provider organization insurance) and 743B.505 (Provider networks).

(6)

Insurance producers shall ensure that enrollees have access to navigators or other assisters to facilitate the diagnosis of hearing loss and needed amplification and ensure that technologies are available to treat hearing loss in enrollees who are 19 years of age or younger. Upon receiving a claim for reimbursement for the diagnosis of hearing loss, an insurer shall provide notice of the coverage limits to the enrollee or to the parent or legal guardian of the enrollee. With respect to enrollees with hearing loss who are younger than 19 years of age, an insurer shall provide educational materials to the parent or legal guardian of the enrollee and shall have a process in place to ensure that appropriate technologies are available.

(7)

The payment, coverage or reimbursement required under this section may be subject to provisions of the health benefit plan that apply to other durable medical equipment benefits covered by the plan, including but not limited to provisions relating to deductibles, coinsurance and prior authorization.

(8)

This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [2009 c.553 §2; 2011 c.500 §42a; 2015 c.515 §26; 2018 c.9 §2]
Note: 743A.141 (Hearing aids and hearing assistive technology systems) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743A.141 — Hearing aids and hearing assistive technology systems, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html.

743A.001
Automatic repeal of certain statutes on individual and group health insurance
743A.010
Services provided by state hospital or state approved program
743A.012
Emergency services
743A.014
Payments for ambulance care and transportation
743A.018
Services provided by osteopathic physician
743A.020
Services provided by acupuncturist
743A.024
Services provided by clinical social worker
743A.028
Services provided by denturist
743A.032
Surgical services provided by dentist
743A.034
Services provided by expanded practice dental hygienist
743A.036
Services provided by licensed nurse practitioner or licensed physician assistant
743A.040
Services provided by optometrist
743A.044
Services provided by physician assistant
743A.048
Services provided by psychologist
743A.051
Services provided by pharmacist
743A.052
Services provided by professional counselor or marriage and family therapist
743A.058
Telemedicine services
743A.060
Definition for ORS 743A.062
743A.062
Prescription drugs
743A.063
Ninety-day supply of prescription drug refills
743A.064
Prescription drugs dispensed at rural health clinics
743A.065
Early refills of prescription eye drops for treatment of glaucoma
743A.066
Contraceptives
743A.067
Reproductive health services
743A.068
Orally administered anticancer medication
743A.069
Insulin
743A.070
Nonprescription enteral formula for home use
743A.078
Newborn nurse home visiting services
743A.080
Pregnancy and childbirth expenses
743A.082
Diabetes management for pregnant women
743A.084
Unmarried women and their children
743A.088
Use by mother of diethylstilbestrol
743A.090
Natural and adopted children
743A.100
Mammograms
743A.104
Pelvic examinations and Pap smear examinations
743A.105
HPV vaccine
743A.108
Physical examination of breast
743A.110
Mastectomy-related services
743A.111
Consumer education about post-mastectomy services
743A.124
Colorectal cancer screenings and laboratory tests
743A.130
Proton beam therapy
743A.140
Bilateral cochlear implants
743A.141
Hearing aids and hearing assistive technology systems
743A.148
Maxillofacial prosthetic services
743A.150
Treatment of craniofacial anomaly
743A.160
Alcoholism treatment
743A.168
Behavioral health treatment
743A.170
Tobacco use cessation programs
743A.175
Traumatic brain injury
743A.180
Tourette Syndrome
743A.185
Telemedical health services for treatment of diabetes
743A.188
Inborn errors of metabolism
743A.190
Children with pervasive developmental disorder
743A.192
Clinical trials
743A.250
Emergency eye care services
743A.252
Child abuse assessments
743A.260
Inmates
743A.262
Preventive health services
743A.264
Disease outbreaks, epidemics and conditions of public health importance
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