Anthem: Important updates on Ohio HB315A and HB315B legislation

Important updates on Ohio HB315A and HB315B legislation

In February, important information about recent federal and state mandates was shared. Below you will find additional updates related to OH HB315A and OH HB315B.

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OH 2025 HB315A Madeline’s Law Hearing Aids for Those Aged 21 or Younger

This law requires health benefit plans to provide coverage for the full cost of medically appropriate hearing aids, up to $2,500 per hearing aid, allowed every 48 months, for people 21 years of age or younger (up to age 22). The determination whether a hearing aid is medically appropriate will be based on standards established by the state speech and hearing professionals’ board.

Coverage must also be provided for related services necessary to assess, select, and appropriately adjust or fit the hearing aid to ensure optimal performance. The $2,500 maximum does not apply to these services. A covered person can purchase a higher-priced hearing aid but will be required to pay the difference in cost above the $2,500 per hearing aid.

UPDATE: Coverage for in-network services will not apply member cost shares, except for high deductible health plans. Certificate amendments have been filed with the Ohio Department of Insurance and are awaiting approval.

• Enactment date: 1/2/25
• UPDATE - Effective date: 4/3/25
• Affects products:
  
  • Comprehensive Medical non-HMO
  • Comprehensive Medical (HMO)
• Affects segments:
  
  • Individual
  • Large Group
  • Small Group
  • MEWA
  • Student Health Plan
  • Affects funding types:
• Fully Insured
  
  • Self-funded non-ERISA public employer plans
  • Self-funded ERISA MEWA

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OH HB315B Occupational Therapy, Physical Therapy, Chiropractic Cost Share

This bill requires a health benefit plan to apply, on a per-day basis, the same cost-sharing requirements for professional occupational therapy, physical therapy, and chiropractic services as the cost-sharing requirement for an office visit to a primary care physician or primary care osteopath physician.

The bill also requires the health plan issuer to clearly state on its website and collateral that the plan has benefits for occupational therapy, physical therapy, and chiropractic services. The website must also list all related limitations, conditions, and exclusions to those services.

UPDATE: Certificate amendments have been filed with the Ohio Department of Insurance and await approval. If physical, occupational, speech, or cognitive rehabilitation therapy is provided for a mental health or substance use disorder condition (based on the primary diagnosis on the claim form), benefits will be paid under the mental health and substance use disorder benefits, as required by law.

• Enactment date: 1/2/25
• UPDATE - Effective date: 4/3/25
• Affects products:
  
  • Comprehensive Medical (HMO) and
  • Comprehensive Medical non-HMO
• Affects segments:
  
  • Individual
  • Large Group
  • Small Group
  • MEWA
  • Student Health Plan
  • Affects funding types:
• Fully Insured
  
  • Self-funded non-ERISA public employer plans
  • Self-funded ERISA MEWA

If you have any questions about these updates, please contact your Anthem representative.

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