Kaiser plans to require in‑network providers for hearing‑aid hardware under new essential‑benefit rule, staff says

Beth Heston, procurement manager for PEB, presented proposed benefit design changes and explained that the Office of the Insurance Commissioner enacted an essential‑benefit change requiring hearing‑aid coverage. She said Kaiser plans will provide hearing‑aid hardware through Kaiser‑owned facilities or contracted in‑network providers; members must use those in‑network providers to receive coverage under Kaiser HMO offerings.

During questions, a board member asked whether cochlear implants were included; Heston said those implants are medically necessary and treated as a separate category. Another board member asked whether Kaiser may still require a statement of medical necessity for specific devices even if the member used an in‑network provider; staff confirmed that a medical‑necessity process could still apply in some cases. Heston emphasized that the change pertains to where the hearing‑aid hardware must be obtained for coverage, and that CDHP members continue to be subject to deductibles.

Board members asked clarifying operational questions about whether contracted community providers could be considered in‑network; staff explained Kaiser has both Kaiser‑owned audiology centers and separately contracted in‑network providers and that coverage applies when the provider is in network.