Section 4N. Any individual or group health maintenance contract that provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide benefits for residents of the commonwealth and to all group members having a principal place of employment within the commonwealth for the expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed as speech-language pathologists or audiologists under chapter 112, if such services are rendered within the lawful scope of practice for such speech-language pathologists or audiologists regardless of whether the services are provided in a hospital, clinic or a private office, and if such coverage shall not extend to the diagnosis or treatment of speech, hearing and language disorders in a school-based setting. The benefits provided by this section shall be subject to the same terms and conditions established for any other medical condition covered by such individual or group health maintenance contract.
An individual or group health maintenance contract, except contracts providing supplemental coverage to Medicare or other governmental programs, shall provide coverage and benefits for children 21 years of age or younger, who are insured under such contracts, for expenses incurred for the cost of 1 hearing aid per hearing impaired ear up to $2,000 for each hearing aid, as defined under section 196 of chapter 112, every 36 months upon a written statement from the child's treating physician that the hearing aids are necessary regardless of etiology. Coverage under this section shall include all related services prescribed by a licensed audiologist or hearing instrument specialist, as defined in said section 196 of said chapter 112, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. The insured may choose a higher priced hearing aid and may pay the difference in cost above the $2,000 limit in this section without any financial or contractual penalty to the insured or to the provider of the hearing aid. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefits provided by the insurer. Nothing in this section shall prohibit an insurer from offering greater coverage for hearing aids than required by this section. This section shall also require coverage for such hearing aids under any non-group policy.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176g - Health Maintenance Organizations
Section 2 - Application of Laws
Section 3 - Organization; Accounting; Contracts
Section 4 - Required Coverage for Certain Conditions and Groups
Section 4a - Employees Terminated Due to Plant Closings; Coverage
Section 4b - Confidentiality of Information; Mental or Nervous Condition; Exceptions
Section 4c - Home Care Benefits
Section 4d - Nonprescription Enteral Formulas for Home Use
Section 4e - Off-Label Drug Use; Cancer Treatment
Section 4f - Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants
Section 4g - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment
Section 4h - Items Medically Necessary for Diagnosis and Treatment of Diabetes
Section 4i - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care
Section 4j - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment
Section 4k - Newborn Hearing Screening Tests
Section 4l - Coverage for Hospice Services
Section 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS
Section 4p - Patient Care Services Provided Pursuant to Qualified Clinical Trials
Section 4q - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing
Section 4s - Coverage for Prosthetic Devices and Repairs
Section 4t - Coverage for Eligible Dependents Under 26 Years of Age
Section 4u - Coverage for Medically Necessary Hypodermic Syringes or Needles
Section 4v - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder
Section 4w - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate
Section 4x - Coverage for Orally Administered Anticancer Medications
Section 4y - Coverage for Abuse Deterrent Opioid Drug Products
Section 4z - Preauthorization for Substance Abuse Treatment Not to Be Required
Section 4aa - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services
Section 4bb - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease
Section 4ee - Pain Management Access Plans
Section 4ff - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products
Section 4hh - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs
Section 4ii - Coverage for Prescription Eye Drops
Section 5 - Emergency Services Provided to Members for Emergency Medical Conditions
Section 5a - Divorced or Separated Spouses; Coverage
Section 6a - Group Health Maintenance Contracts; Contribution Percentages
Section 6b - Retroactive Claims Denials for Behavioral Health Services
Section 8 - Public Dissemination of Deceptive or Misleading Materials
Section 9 - Trade Regulation Practices; Application of Law
Section 10 - Reports; Audits, Examinations or Inspections; Confidentiality and Privilege
Section 11 - Contracts With Group Insurance Commission or Local Governments
Section 11a - Alternative Dental Coverage Option
Section 12 - Health Regulations Not Limited
Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner
Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner
Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles
Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults
Section 17 - Rules and Regulations; Standardized Claim Form
Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination
Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract
Section 23 - Insolvency of Health Maintenance Organization; Replacement Coverage
Section 25 - Net Worth of Health Maintenance Organization
Section 26 - Deposit Maintained With Trustee Acceptable to Commissioner
Section 27 - Merger or Acquisition of Control
Section 28 - Registration With Commissioner
Section 30 - Statement for Individuals Provided With Creditable Coverage; Reporting
Section 31 - Attribution of Members to a Primary Care Provider