H.R. 4606 — Ally’s Act

This section requires group health plans and health insurance issuers offering group or individual health insurance coverage, under the Public Health Service Act, ERISA, and the Internal Revenue Code, to cover auditory implant devices (i.e., cochlear implants and bone conduction implants), external sound processors, and related items and services—including maintenance; upgrades or replacements every five years; repairs; adhesive adapters and softband headbands; hearing and preoperative assessments; surgery; postoperative medical and audiological visits; and aural rehabilitation—for qualifying individuals (i.e., those determined by a physician or qualified audiologist to need such devices). Coverage must apply financial requirements and treatment limitations no more restrictive than those for substantially all medical and surgical benefits, with no separate cost-sharing or treatment limits, and plans and issuers may not deny coverage deemed medically necessary by such providers. (As background, these requirements expand ACA market reforms to mandate first-dollar parity coverage for advanced hearing loss treatments previously often excluded or limited.)