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Board briefed on law forcing hearing-aid coverage with no dollar limits starting 2026
Summary
Staff told the Public Employees Benefits Board that a 2025 state law requires plans issued/renewed on or after Jan. 1, 2026, to cover medically necessary hearing instruments every 36 months without annual or lifetime dollar limits; staff proposed rescinding the 2023 hearing-aid resolution and replacing it with a 2026 resolution. Board will vote July 10.
Ryan Ramsdell, UMP TPA team account manager in the IRB division, told the board that Substitute Senate Bill 5262 and a related amendment to RCW 48.43.135 require coverage for medically necessary hearing instruments every 36 months without annual or lifetime dollar limits for plans issued or renewed on or after Jan. 1, 2026. "It requires that health plans issued or renewed on or after 01/01/2026 shall provide coverage for medically necessary hearing instruments every 36 months, and this is the important part, without any lifetime or lifetime or annual limits on the dollar amount of coverage whether provided in network or out of network," Ramsdell said.
Staff explained how the change affects current board policy: the existing PEP resolution PEP 2023-03 (adopted 06/08/2023) that set a $3,000 per-ear allowance will be rescinded effective 01/01/2026 and replaced with proposed resolution PEP 2025-06, which would adopt 100% of the allowed amount every 36 months. Ramsdell noted member benefit accumulators will not reset on Jan. 1, 2026, so members with recent hearing-aid activity should expect the same 36-month clock to continue. The board heard questions about network impact and provider participation; staff said they will confirm whether vendors such as Costco accept the Regents contract and will return with that information before the July 10 vote.
The proposed replacement resolution is informational today; no vote was taken. Staff said they will include communications to members during open enrollment and will present the resolution for formal action at the July 10, 2025 meeting.
