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NC Hearing Aid Mandate Effective for January 1, 2011

Revised Article Issued: December 15, 2010

The North Carolina legislature has passed an act requiring health benefit plans and the State Health Plan to cover hearing aids and replacement hearing aids for covered individuals under the age of 22. This act becomes effective January 1, 2011 and applies to health benefit plans that are delivered, issued for delivery, or renewed on and after that date.

What will change?

Blue Cross and Blue Shield of North Carolina (BCBSNC) has modified our benefit plans to include the following hearing aid coverage:

  • One hearing aid per hearing-impaired ear up to $2,500 per hearing aid every 36 months for covered members under the age of 22 years.
  • Benefits include initial hearing aid evaluation, fitting and adjustments and supplies including ear molds.
  • This is a 36-month benefit per anatomical location, meaning hearing aids for the left and right ears could have a different 36-month coverage period.

Changes to member's benefits made to comply with state mandates apply to both - grandfathered* and non-grandfathered plans. The law states health insurers may apply utilization review criteria to determine medical necessity as defined by G.S. 58-50-61, as long as it does so in accordance with all requirements for utilization review programs and medical necessity determinations. Subsequently, existing BCBSNC medical policy disallowing hearing aids as a non-available benefit option will not preclude services for members eligible for hearing aid coverage.

When will these benefit changes take effect for BCBSNC members?

  • Individual policies -- January 1, 2011, for all policies
  • Group policies -- as of renewal beginning January 1, 2011
  • State Health Plan -- July 1, 2011

Additional information

Additional information regarding HB 589 can be obtained by accessing the General Assembly of North Carolina Web site at:

http://www.ncleg.net/Sessions/2009/Bills/House/PDF/H589v7.pdf

BCBSNC Network Management is also available to assist regarding these benefit design changes. Please contact your regional Network Management representative if you have questions.

*Previously, we had erroneously communicated that changes to member's benefits made to comply with state mandates affect only those groups without grandfathered status and grandfathered groups were not being impacted.