Bill > HB1669

This bill requires health insurance plans in the large and small group markets, starting January 1, 2026, to provide comprehensive coverage for prosthetic limbs and custom orthotic braces. The coverage must enable enrollees to complete daily living activities, perform job-related tasks, and engage in physical activities like running, biking, swimming, and strength training. The bill mandates that insurers cover not just the devices themselves, but also materials, components, related services, user instructions, and reasonable repairs or replacements. Importantly, the coverage must allow for device replacement without lifetime restrictions if medically necessary, such as due to changes in the patient's physiological condition or device condition. The bill also prohibits insurers from denying coverage for individuals with disabilities if similar medical services would be covered for non-disabled individuals. Health plans can still apply standard utilization management and prior authorization practices, but must provide written explanations for any coverage denials. Additionally, the payment for these prosthetic and orthotic devices must meet or exceed federal coverage standards for aged and disabled populations. This legislation aims to improve access to essential medical devices that support individuals' mobility, functionality, and quality of life.