New Jersey Amends Grace’s Law
The amendments to Grace's Law expand health benefit coverage for hearing aids and provide coverage for cochlear implants.
Published: 10.18.2024
On January 16, 2024, Governor Murphy signed P.L 2023 c.275. This new law has amended Grace’s Law, which initially mandated a level of hearing aid coverage for children 15 and younger. The newly enacted changes to Grace’s Law expand various health benefits coverages for hearing aids and now also provide coverage for cochlear implants. These new amendments to Grace’s Law went into effect 90 days after the bill’s signing date of January 16, 2024, meaning the changes took effect April 15, 2024 for new business and groups as they renewed on or after that date.Initially Grace’s Law, P. L. 2008, c. 126, effective March 30, 2009, required health insurance carriers, including hospital, medical and health service corporations; individual and group health insurance companies; Health Maintenance Organizations (HMOs); health benefits plans issued pursuant to the Individual Health Coverage (IHC) and Small Employer Health Benefits (SEH) Programs; the State Health Benefits Plan (SHBP) and the NJ FamilyCare Program to provide benefits for medically necessary expenses incurred in the purchase of a hearing aid for a covered person 15 years of age or younger. It is written into every NJ SEH contract.
The new law applies to all NJ fully-insured, individual plans, the State Health Benefits Plan (SHBP), NJ FamilyCare, and small and large group plans effective for new business and as plans renew April 15, 2024 and after.
Amendments and Differences to Note
Individual, NJ FamilyCare, Small and Large Group Fully-Insured Plans
- The age limit has been removed to state the law applies to “All covered persons”
- Hearing aids, 1 for each ear every 24 months (not every 2 yrs i.e., 24 months from the previous purchase)
- Must be medically necessary and prescribed by a licensed physician or audiologist
- Includes coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device, including replacement of obsolete external cochlear implant processors
- The benefits shall be provided to the same extent as for any other condition under the contract.
- The age limit has been amended to state the law applies to a “covered person 21 years of age or younger”
- Hearing aids, 1 for each ear every 60 months (not every 5 yrs i.e., 60 months from the previous purchase)
- Commission may limit the benefit to $2,500 per hearing aid for each ear
- Must be medically necessary and prescribed by a licensed physician or audiologist
- Includes coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device, including replacement of obsolete external cochlear implant processors
- The age limit has been removed to state “All covered persons”
- Hearing aids, 1 for each ear every 60 months (not every 5 yrs i.e., 60 months from the previous purchase)
- Commission may limit the benefit to $2,500 per hearing aid for each ear
- Must be medically necessary and prescribed by a licensed physician or audiologist
- Includes coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device, including replacement of obsolete external cochlear implant processors
