Bill > HB87

This bill requires health insurance policies in Georgia to cover medically necessary orthotic and prosthetic devices starting January 1, 2026. The legislation defines key terms like "orthotic device" (a custom-made external support to help with physical function) and "prosthetic device" (a custom device replacing an absent body part), and mandates that health insurers provide coverage for these devices when they are needed for daily living activities, job-related tasks, personal hygiene, and physical activities. The bill allows up to three devices per affected limb every three years and requires coverage of not just the device itself, but also its materials, components, design, fittings, educational training, and repairs. Importantly, replacements can be covered before the three-year period if there are documented physiological changes or significant device damage. The coverage must be comparable to other medical benefits, can have similar cost-sharing requirements, and insurers are allowed to provide more generous benefits. By July 1, 2032, the insurance commissioner must submit a report on the implementation of this coverage, including data on claims submitted and paid. The bill aims to ensure that individuals with physical conditions or disabilities have improved access to necessary medical devices that can enhance their mobility and quality of life.

Business and Industry, Health and Social Services

https://www.legis.ga.gov/legislation/69426