Bill > HB0564

This bill amends Utah's health insurance law to expand coverage for prosthetic and orthotic devices. The bill clarifies definitions of orthotic and prosthetic devices, specifying that orthotic shoes or inserts are only covered if they are part of a brace. It requires health insurers to offer at least one plan that covers prosthetic devices, including all services necessary for their effective use, such as design, fabrication, measurements, fittings, and patient instruction. The bill mandates that insurers cover repairs or replacements of prosthetic devices that are medically necessary to help patients complete daily or job-related activities. A significant new provision requires health benefit plans to include coverage for an additional prosthetic or orthotic device if a treating physician determines it is necessary for physical and recreational activities like running, bicycling, swimming, and various sports. This coverage applies to health benefit plan contracts entered into or renewed after July 1, 2026. The bill also maintains existing provisions about cost-sharing and allows insurers to limit coverage for microprocessor components to $30,000 per limb every three years. The legislation will take effect on May 7, 2025, potentially improving access to prosthetic technologies for individuals with limb differences or disabilities.

https://le.utah.gov/~2025/bills/static/HB0564.html