Bill > H906

This bill, named Reagan's Law, requires health benefit plans in North Carolina to provide comprehensive coverage for prosthetic and orthotic devices for individuals with limb loss or limb difference. Specifically, the bill mandates that health insurers cover all prosthetic and orthotic devices required under Medicare Part B, including materials, components, usage instructions, and device repairs or replacements. The coverage must include devices determined by healthcare providers to be the most appropriate for daily living and job-related activities, and is not limited to a single device. The bill goes beyond basic functionality, requiring coverage for additional devices that support physical activities like running, biking, and strength training, and that maximize overall body health and limb function. Insurers cannot deny claims for prosthetic devices for individuals with limb loss that would be covered for individuals without disabilities. The bill also stipulates that device replacements can be made without restrictions if a healthcare provider determines it necessary due to changes in the patient's physiological condition, device condition, or when repair costs exceed 60% of replacement costs. Health benefit plan issuers must report claims data to the North Carolina Department of Insurance by February 1, 2028, and the Commissioner will then provide an aggregated report to legislative oversight committees. The law will take effect on October 1, 2025, and will apply to new, renewed, or amended insurance contracts from that date.

Business and Industry, Government Affairs, Health and Social Services

https://www.ncleg.gov/BillLookUp/2025/H906