Bill
HB 4963
Requires Michigan insurers to cover hearing-related services and devices for minors under 19 with diagnosed or suspected hearing loss.
Status: Referred to Committee on Health Policy (House); introduced Sept. 7, 2023 (Rep. Samantha Steckloff). Passed House (substitute H‑4) Dec. 3, 2024; awaiting companion action (see “Condition for effect”). Effective date in reported/passed versions: policies delivered, issued, amended, adjusted, or renewed beginning January 1, 2026 (earlier draft used 180 days after enactment).
Purpose
- Require health insurers writing policies in Michigan to cover hearing‑related services and devices for certain minors to improve access to early diagnosis and treatment of pediatric hearing loss.
Key provisions
- Mandatory coverage: Insurers that deliver, issue, or renew health insurance policies in Michigan must provide coverage for “hearing‑related services and devices” for a “qualified enrollee.”
- Qualified enrollee: Generally defined as an enrollee under 19 years of age who has been evaluated by an audiologist for hearing loss. In the House‑passed substitute, an otolaryngologist must also medically evaluate the child, determine they are a candidate for a hearing aid, and refer the child to the audiologist for evaluation, selection, and fitting.
- Scope of covered services and devices (examples listed explicitly):
- Audiological examinations and services necessary to assess, select, fit, adjust, and ensure optimal performance of hearing aids.
- Hearing aid evaluations, programming, verification, servicing, maintenance, and repairs.
- Remote microphones.
- Earmolds and replacement earmolds.
- Auditory training and speech‑language habilitation provided by audiologists and speech‑language pathologists.
- Cost‑sharing: Coverage may be subject to applicable cost‑sharing under the health plan (deductible, co‑insurance, co‑pays).
- HSA/qualified health plan carve‑out: The House substitute exempts application to qualified health plans after the health savings account (HSA) deductible is met where necessary to preserve the insured’s tax‑advantaged HSA status under IRS rules.
- Interplay with HB 4944: HB 4963 was developed alongside HB 4944. HB 4944 would require coverage specifically for hearing aids and, in the reported version, set a maximum required insurer contribution of $3,000 per hearing aid every 36 months (adjusted annually by the Consumer Price Index), with enrollees responsible for any amount above that cap. Neither bill takes effect unless both are enacted.
Who is affected
- Insurers offering individual, group, or other health policies delivered, issued, or renewed in Michigan (and out‑of‑state policies covering Michigan residents).
- Children under 19 with diagnosed or suspected hearing loss and their families.
- Providers involved in pediatric hearing care: audiologists, otolaryngologists, speech‑language pathologists, hearing instrument specialists, and related vendors (hearing aids, remote microphones, earmolds, repair services).
- Employers (self‑insured plans may be impacted depending on federal preemption/ERISA considerations — bill applies to state‑regulated policies).
Fiscal and policy notes
- House Fiscal Agency analyses reported no fiscal impact on the Department of Insurance and Financial Services or other state/local units.
- Supporters (testimony) cited prevalence of pediatric hearing loss and benefits of early intervention. Opponents (industry groups) raised concerns about insurer cost exposure and market impacts.
- Procedural condition: Multiple versions state the act “does not take effect unless” the companion bill (HB 4944) is enacted, so passage of both is necessary for implementation.
Compiled from official sources — confirm details with the bill’s official record.
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