Bill > H0432

This bill proposes to expand health insurance coverage requirements for prosthetic and orthotic devices in Vermont, significantly enhancing the existing law. The bill mandates that health insurance plans provide comprehensive coverage for prosthetic and orthotic devices that meet an individual's medical needs, including devices for physical activities like running, swimming, and strength training, as well as devices for basic functions like showering. The coverage must be at least equivalent to Medicare standards and cannot be denied based on disability. Health insurers must cover not just the devices themselves, but also necessary materials, components, instructions for use, and medically necessary repairs or replacements. The bill requires insurers to ensure access to at least two in-state prosthetic and orthotic providers and prohibits annual or lifetime dollar maximums that are less favorable than those applied to other services. Additionally, the bill requires health insurers to report their claims experience for prosthetic and orthotic devices for plan years 2026, 2027, and 2028 to the Department of Financial Regulation, which will then compile an aggregated report for legislative committees. The new coverage requirements will take effect on January 1, 2026, and apply to all health insurance plans as they are renewed or issued, with a final implementation deadline of January 1, 2027.

Health and Social Services

https://legislature.vermont.gov/bill/status/2026/H.432