(1) As used in this section, “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.
(2) A health benefit plan, as defined in ORS 743B.005 (Definitions), shall provide payment, coverage or reimbursement for 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:
(A) 18 years of age or younger; or
(B) 19 to 25 years of age and enrolled in a secondary school or an accredited educational institution.
(3)(a) The maximum benefit amount required by this section is $4,000 every 48 months, but a health benefit plan may offer a benefit that is more favorable to the enrollee. An insurer shall adjust the benefit amount on January 1 of each year to reflect the increase since January 1, 2010, in the U.S. City Average Consumer Price Index for All Urban Consumers for medical care as published by the Bureau of Labor Statistics of the United States Department of Labor.
(b) An insurer may not impose any financial or contractual penalty upon an audiologist if an enrollee elects to purchase a hearing aid priced higher than the benefit amount by paying the difference between the benefit amount and the price of the hearing aid.
(4) 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.
(5) 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]
Note: 743A.141 (Hearing aids) 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.
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.