FYI ALERT
Hi! I have been getting MANY email messages from people with questions on the state implementation of Grace's Law; insurance company compliance, why self-funded plans aren't covered etc. I got a response from DOBI today on some of my questions. (This is a long message with important information - see below.)
There is an exception to the law and for people with self-funded insurers they are protected federally and they do not have to follow state mandates. Unfortunately, many people are just now finding out that they have self-funded plans. Self-funded plans are protected federally by ERISA. There is nothing anyone can do about that. This is why I continually stress the need for federal insurance reform. This is a national problem. I also recommend you learn more about the Federal Hearing Aid Tax Credit that they are trying to pass and help to gain support of it.
I strongly recommend that everyone confirm IF YOUR EMPLOYER HAS A SELF-FUNDED PLAN. IF THEY DO NOT THEN THEY WILL HAVE TO FOLLOW THE GRACE'S LAW MANDATE WHEN IT IS EFFECTIVE 3/30. (However, if you read further below there is a caveat to this as well) IF THEY HAVE A SELF-FUNDED PLAN, THEN GRACE'S LAW WONT APPLY TO THEM AND YOU NEED NOT WAIT TILL APRIL. But personally, I would fight and appeal and say that medical professionals deem hearing aids medically necessary and now the state of NJ government does as well.
I strongly recommend you refer your questions to the following government agencies:
1) NJ's Department of Banking and Insurance 609-292-7272 1-800-446-7467
This department is responsible for informing the insurance companies etc.
2) NJ's Division of Deaf and Hard of Hearing 609-984-7281 800-792-8339
Both of the above websites have online email forms that can be submitted as well.The DDHH has plans to produce a guide for NJ consumers on questions regarding NJ's hearing aid insurance legislation."
Read the response below from DOBI. Just because the law is effective on 3/30 it does not mean insurers have to pay for hearing aids in April. It is when their plans renew (which for most of us is typically January!!!). I strongly urge everyone to forward this to people who are considering purchasing hearing aids in the near future or to schools, etc. etc.
Jeanine Gleba
RESPONSE FROM DOBI RE SELF FUNDED INSURANCE PLANS
As you stated in your email, P.L. 2008, c. 126 (Grace's Law) was approved on December 30, 2008 and becomes effective on March 30, 2009. The law does not apply to self-funded plans, with the exception of the State Health Benefits Plan. Regarding insured plans, the law does not automatically become effective on April 1, 2009; rather, the law applies as plans renew and are issued after March 30, 2009. Insurers have legal and governmental affairs departments that are responsible for monitoring legislation, and they would be aware of Grace's Law. Insurers will provide covered persons with amendments to their certificates of coverage that will explain the mandate.
You may refer additional questions regarding Grace's Law to the following individuals:
For small employer and individual health plans, For large group health benefits plans,
Ellen DeRosa, Executive Director Gale Simon, Assistant Commissioner
IHC and SHE Programs Dep't of Banking & Insurance
PO Box 325 PO Box 325
Trenton, NJ 08625-0325 Trenton, NJ 08625-0325
Phone: 609-633-1882 Phone: 609-292-5427 x50341
Email: ellen.derosa@dobi.state.nj.us ellen.derosa@dobi.state.nj.us
Email: gale.simon@dobi.state.nj.us gale.simon@dobi.state.nj.us>
For the NJ State Health Benefits Program, NJ Dep't of Treasury
Division of Pensions & Benefits
State Health Benefits Program
PO Box 002
Trenton, NJ 08625-0002
I trust this has been responsive to your inquiry.
Bonnie E. Bajor,
Regulatory Officer
NJ Dep't of Banking & Insurance
Legislative & Regulatory Affairs
Here is another interesting answer from DOBI regarding the amount:
Grace's Law states that the carrier "may limit the benefit . . . to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher . . . and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid."
A carrier who currently provides no benefit for hearing aids may choose to limit the benefit under Grace's Law to $1,000 per hearing aid for each ear every two years. If a carrier currently provides some benefit for hearing aids, but less than $1,000 per hearing aid, Grace's Law would require the carrier to pay at least $1,000 per hearing aid. In both cases, the carrier may choose to pay more than $1,000 per hearing aid. As stated in our initial reply to you, these requirements apply as plans renew and are issued after March 30, 2009. Accordingly, whether a carrier currently provides no benefit for hearing aids, or currently provides some benefit in any amount, the carrier must provide a hearing aid benefit when the plan renews or is isued after March 30, 2009, but may limit that benefit to $1,000 per hearing aid.
