I 
119TH CONGRESS 
1ST SESSION H. R. 4606 
To amend title XXVII of the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, the Internal Revenue Code 
of 1986, and the Patient Protection and Affordable Care Act to require 
coverage of hearing devices and systems in certain private health insur-
ance plans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 22, 2025 
Mr. NEGUSE (for himself, Mr. FITZPATRICK, Mr. POCAN, and Mr. RUTHER-
FORD) introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committees on Edu-
cation and Workforce, and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XXVII of the Public Health Service Act, 
the Employee Retirement Income Security Act of 1974, 
the Internal Revenue Code of 1986, and the Patient 
Protection and Affordable Care Act to require coverage 
of hearing devices and systems in certain private health 
insurance plans, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ally’s Act’’. 
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SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 
CERTAIN 
PRIVATE 
HEALTH 
INSURANCE 
PLANS. 
(a) PHSA.—Part D of the Public Health Service Act 
(42 U.S.C. 300gg–111 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 2799A–11. COVERAGE OF HEARING DEVICES AND SYS-
TEMS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage shall at a minimum provide coverage for 
the following items and services furnished to a qualifying 
individual (as defined in subsection (d)): 
‘‘(1) Auditory implant devices (including audi-
tory osseointegrated (bone conduction) implants and 
cochlear implants) and external sound processors. 
‘‘(2) The maintenance of auditory implant de-
vices and external sound processors described in 
paragraph (1). 
‘‘(3) Every 5 years, the upgrade (or replace-
ment if an upgrade is not available) of auditory im-
plant devices and external sound processors de-
scribed in paragraph (1). 
‘‘(4) Adhesive adapters and softband head-
bands. 
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‘‘(5) The repair of auditory implant devices and 
external sound processors described in paragraph 
(1). 
‘‘(6) A comprehensive hearing assessment. 
‘‘(7) A preoperative medical assessment. 
‘‘(8) Surgery relating to the furnishing of such 
devices and processors (as determined necessary by 
a physician or qualified audiologist (as such terms 
are defined for purposes of subsection (d)) treating 
such individual). 
‘‘(9) Postoperative medical visits for purposes 
of ensuring appropriate recovery from such surgery. 
‘‘(10) Postoperative audiological visits for acti-
vation and fitting of such devices and processors. 
‘‘(11) Aural rehabilitation and treatment serv-
ices (as so determined necessary). 
‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 
item or service described in subsection (a) furnished to 
a qualifying individual under a group health plan or group 
or individual health insurance coverage, such plan or cov-
erage shall ensure that— 
‘‘(1) the financial requirements (as defined in 
section 2726(a)(3)) applicable to such item or serv-
ice are no more restrictive than the predominant fi-
nancial requirements applied to substantially all 
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medical and surgical benefits covered by the plan or 
coverage (as applicable), and that there are no sepa-
rate cost sharing requirements that are applicable 
only with respect to such item or service; and 
‘‘(2) the treatment limitations (as defined in 
such section) applicable to such item or service are 
no more restrictive than the predominant treatment 
limitations applied to substantially all medical and 
surgical benefits covered by the plan or coverage (as 
applicable), and that there are no separate treat-
ment limitations that are applicable only with re-
spect to such item or service. 
‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES-
SITY.—A group health plan and a health insurance issuer 
offering group or individual health insurance coverage 
may not deny or otherwise limit coverage of any item or 
service described in subsection (a) where such item or 
service has been determined to be medically necessary by 
a physician or qualified audiologist (as such terms are de-
fined in subsection (d)). 
‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur-
poses of this section, the term ‘qualifying individual’ 
means an individual that a physician (as defined in section 
1861(r) of the Social Security Act) or qualified audiologist 
(as defined in section 1861(ll)(4)(B) of such Act) deter-
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mines meets an indication (including unilateral or bilateral 
hearing loss) for an auditory implant device and external 
sound processor described in subsection (a)(1).’’. 
(b) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) by 
adding at the end the following new section: 
‘‘SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
shall at a minimum provide coverage for the following 
items and services furnished to a qualifying individual (as 
defined in subsection (d)): 
‘‘(1) Auditory implant devices (including audi-
tory osseointegrated (bone conduction) implants and 
cochlear implants) and external sound processors. 
‘‘(2) The maintenance of auditory implant de-
vices and external sound processors described in 
paragraph (1). 
‘‘(3) Every 5 years, the upgrade (or replace-
ment if an upgrade is not available) of auditory im-
plant devices and external sound processors de-
scribed in paragraph (1). 
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‘‘(4) Adhesive adapters and softband head-
bands. 
‘‘(5) The repair of auditory implant devices and 
external sound processors described in paragraph 
(1). 
‘‘(6) A comprehensive hearing assessment. 
‘‘(7) A preoperative medical assessment. 
‘‘(8) Surgery relating to the furnishing of such 
devices and processors (as determined necessary by 
a physician or qualified audiologist (as such terms 
are defined for purposes of subsection (d)) treating 
such individual). 
‘‘(9) Postoperative medical visits for purposes 
of ensuring appropriate recovery from such surgery. 
‘‘(10) Postoperative audiological visits for acti-
vation and fitting of such devices and processors. 
‘‘(11) Aural rehabilitation and treatment serv-
ices (as so determined necessary). 
‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 
item or service described in subsection (a) furnished to 
a qualifying individual under a group health plan or group 
health insurance coverage, such plan or coverage shall en-
sure that— 
‘‘(1) the financial requirements (as defined in 
section 2726(a)(3) of the Public Health Service Act) 
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applicable to such item or service are no more re-
strictive than the predominant financial require-
ments applied to substantially all medical and sur-
gical benefits covered by the plan or coverage (as ap-
plicable), and that there are no separate cost sharing 
requirements that are applicable only with respect to 
such item or service; and 
‘‘(2) the treatment limitations (as defined in 
such section) applicable to such item or service are 
no more restrictive than the predominant treatment 
limitations applied to substantially all medical and 
surgical benefits covered by the plan or coverage (as 
applicable), and that there are no separate treat-
ment limitations that are applicable only with re-
spect to such item or service. 
‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES-
SITY.—A group health plan and a health insurance issuer 
offering group health insurance coverage may not deny or 
otherwise limit coverage of any item or service described 
in subsection (a) where such item or service has been de-
termined to be medically necessary by a physician or quali-
fied audiologist (as such terms are defined in subsection 
(d)). 
‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur-
poses of this section, the term ‘qualifying individual’ 
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means an individual that a physician (as defined in section 
1861(r) of the Social Security Act) or qualified audiologist 
(as defined in section 1861(ll)(4)(B) of such Act) deter-
mines meets an indication (including unilateral or bilateral 
hearing loss) for an auditory implant device and external 
sound processor described in subsection (a)(1).’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1001 et seq.) 
is amended by inserting after the item relating to 
section 725 the following new item: 
‘‘Sec. 726. Coverage of hearing devices and systems.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
‘‘SEC. 9826. COVERAGE OF HEARING DEVICES AND SYS-
TEMS. 
‘‘(a) IN GENERAL.—A group health plan shall at a 
minimum provide coverage for the following items and 
services furnished to a qualifying individual (as defined 
in subsection (d)): 
‘‘(1) Auditory implant devices (including audi-
tory osseointegrated (bone conduction) implants and 
cochlear implants) and external sound processors. 
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‘‘(2) The maintenance of auditory implant de-
vices and external sound processors described in 
paragraph (1). 
‘‘(3) Every 5 years, the upgrade (or replace-
ment if an upgrade is not available) of auditory im-
plant devices and external sound processors de-
scribed in paragraph (1). 
‘‘(4) Adhesive adapters and softband head-
bands. 
‘‘(5) The repair of auditory implant devices and 
external sound processors described in paragraph 
(1). 
‘‘(6) A comprehensive hearing assessment. 
‘‘(7) A preoperative medical assessment. 
‘‘(8) Surgery relating to the furnishing of such 
devices and processors (as determined necessary by 
a physician or qualified audiologist (as such terms 
are defined for purposes of subsection (d)) treating 
such individual). 
‘‘(9) Postoperative medical visits for purposes 
of ensuring appropriate recovery from such surgery. 
‘‘(10) Postoperative audiological visits for acti-
vation and fitting of such devices and processors. 
‘‘(11) Aural rehabilitation and treatment serv-
ices (as so determined necessary). 
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‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 
item or service described in subsection (a) furnished to 
a qualifying individual under a group health plan, such 
plan shall ensure that— 
‘‘(1) the financial requirements (as defined in 
section 2726(a)(3) of the Public Health Service Act) 
applicable to such item or service are no more re-
strictive than the predominant financial require-
ments applied to substantially all medical and sur-
gical benefits covered by the plan, and that there are 
no separate cost sharing requirements that are ap-
plicable only with respect to such item or service; 
and 
‘‘(2) the treatment limitations (as defined in 
such section) applicable to such item or service are 
no more restrictive than the predominant treatment 
limitations applied to substantially all medical and 
surgical benefits covered by the plan, and that there 
are no separate treatment limitations that are appli-
cable only with respect to such item or service. 
‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES-
SITY.—A group health plan may not deny or otherwise 
limit coverage of any item or service described in sub-
section (a) where such item or service has been determined 
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to be medically necessary by a physician or qualified audi-
ologist (as such terms are defined in subsection (d)). 
‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur-
poses of this section, the term ‘qualifying individual’ 
means an individual that a physician (as defined in section 
1861(r) of the Social Security Act) or qualified audiologist 
(as defined in section 1861(ll)(4)(B) of such Act) deter-
mines meets an indication (including unilateral or bilateral 
hearing loss) for an auditory implant device and external 
sound processor described in subsection (a)(1).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by inserting 
after the item relating to section 9825 the following 
new item: 
‘‘Sec. 9286. Coverage of hearing devices and systems.’’. 
(d) APPLICATION
TO GRANDFATHERED HEALTH 
PLANS.—Section 1251(a)(4)(A) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 
amended— 
(1) by striking ‘‘title’’ and inserting ‘‘title, or as 
added after the date of the enactment of this Act)’’; 
and 
(2) by adding at the end the following new 
clause: 
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‘‘(v) Section 2799A–11 (relating to 
hearing devices and systems).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2026. 
Æ 
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