Amendment AA3-ASA1-AB16

LRBa0169/1

PJK:jld:ph

2009 - 2010 LEGISLATURE

ASSEMBLY AMENDMENT 3, TO ASSEMBLY SUBSTITUTE AMENDMENT 1, TO 2009 ASSEMBLY BILL 16

March 26, 2009 - Offered by Representative Nygren.

AB16-ASA1-AA3,1,1 At the locations indicated, amend the substitute amendment as follows:

AB16-ASA1-AA3,1,3 1. Page 4, line 18: delete the material beginning with that line and ending with page 5, line 11, and substitute:

AB16-ASA1-AA3,1,10 "(b) 1. Subject to par. (c) and except as provided in par. (d), every disability insurance policy and every self-insured health plan shall provide coverage of the cost of hearing aids and cochlear implants that are prescribed by a physician, or by an audiologist licensed under subch. II of ch. 459, in accordance with accepted professional medical or audiological standards, for a child covered under the policy or plan who is under 18 years of age and who is certified as deaf or hearing impaired by a physician or by an audiologist licensed under subch. II of ch. 459.

AB16-ASA1-AA3,2,3 2. The coverage required under this subsection shall include coverage of treatment related to the hearing aids and cochlear implants, including procedures for the implantation of cochlear devices.

AB16-ASA1-AA3,2,6 3. Coverage of the cost of hearing aids and related treatment under this subsection is not required to exceed the cost of one hearing aid and related treatment per ear per child more often than once every 3 years.

AB16-ASA1-AA3,2,10 4. The coverage required under this subsection may be subject to any cost-sharing provisions, limitations, or exclusions, other than a preexisting condition exclusion, that apply generally under the disability insurance policy or self-insured health plan.".

AB16-ASA1-AA3,2,11 2. Page 5, line 12: delete "par. (b) 3." and substitute "par. (b) 4.".

AB16-ASA1-AA3,2,12 3. Page 6, line 2: after that line insert:

AB16-ASA1-AA3,2,18 "3. If an insurer denies coverage under an individual disability insurance policy to a child or the child's family and the child would be eligible as specified in par. (b) 1. for coverage of hearing aids and cochlear implants and related treatment, the insurer shall advise the child's family of the availability of coverage for hearing aids and cochlear implants and related treatment under the BadgerCare Plus program under s. 49.471 under the benefits described in s. 49.46 (2) (a) and (b).".

AB16-ASA1-AA3,2,19 4. Page 6, line 4: after that line insert:

AB16-ASA1-AA3,2,22 "1m. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.".

AB16-ASA1-AA3,2,23 5. Page 6, line 9: after that line insert:

AB16-ASA1-AA3,3,4 "5. An individual health benefit plan that is not renewable and that has a specified termination date that, including any extensions that the policyholder may elect without the insurer's consent, is less than 12 months after the original effective date.".

AB16-ASA1-AA3,3,5 (End)