H.R. 4606: Ally’s Act

This bill, known as Ally's Act, aims to amend several existing laws related to health insurance to ensure broader coverage for hearing devices and associated services. Here is a breakdown of its key provisions:

Coverage Requirements

The bill requires that group health plans and health insurance issuers, whether for employers or for individual policyholders, must provide coverage for several specific items and services related to hearing devices. These include:

• Auditory implant devices, including cochlear implants and bone conduction implants.
• Maintenance and repair of these auditory devices.
• Upgrades or replacements of these devices every five years, if an upgrade is not available.
• Accompanying items like adhesive adapters and softband headbands.
• A comprehensive hearing assessment.
• Preoperative and postoperative assessments related to surgery for the devices.
• Aural rehabilitation and treatment services as deemed necessary by a medical professional.

Coverage Conditions

Any health plan providing coverage for these services must ensure that:

• The financial implications (like copayments or deductibles) for hearing devices are no more restrictive than those for general medical and surgical benefits.
• There aren’t separate treatment limits for hearing device services that are stricter than those for other covered benefits.
• If a qualified physician or audiologist deems the services medically necessary, the insurance cannot deny or limit coverage for those services.

Definitions

The bill also provides a definition for "qualifying individuals," specifying that they are those for whom a physician or qualified audiologist determines may benefit from the auditory devices mentioned in the bill.

Applicable Laws

The bill modifies the following laws to include the new coverage requirements:

• Public Health Service Act
• Employee Retirement Income Security Act (ERISA)
• Internal Revenue Code
• Patient Protection and Affordable Care Act

Effective Date

The changes proposed by this legislation would become effective for plan years starting on or after January 1, 2026.

Relevant Companies

• PHG (Royal Philips) - A major manufacturer of hearing aids and auditory implant devices, likely to see increased demand for its products under this expanded coverage.
• WSO (Walmart Inc.) - As a retailer that offers health services, Walmart may benefit from expanded coverage options and the sale of hearing devices.
• DEO (DeVry University) - Involved in audiology training and services, may see increased enrollment in programs due to a growing need for audiologists as coverage expands.