Bill > A3856

This bill requires various types of health insurance providers in New Jersey to expand coverage for orthotic and prosthetic appliances in two key ways. First, these providers must now cover orthotic and prosthetic appliances obtained from licensed orthotists, prosthetists, podiatrists, or certified pedorthists when the appliance is determined to be medically necessary by a physician. Second, the bill mandates coverage for an additional orthotic or prosthetic appliance specifically to enable the covered person to participate in physical and recreational activities such as running, bicycling, swimming, skiing, and team sports, provided that a physician determines the additional appliance is necessary for these purposes. The bill applies to hospital service corporations, medical service corporations, health service corporations, individual and group health insurance policies, individual and small employer health benefits plans, health maintenance organizations, and State Health Benefits Commission contracts. These providers must reimburse for such appliances at the same rate as the federal Medicare reimbursement schedule and provide these benefits to the same extent as any other medical condition. The changes will take effect 90 days after enactment and will apply to policies or contracts issued or renewed after that date.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/A3856