Bill > HB564

This bill requires health insurance plans in Ohio to provide comprehensive coverage for orthotic and prosthetic devices, ensuring that individuals with limb loss, absence, or difference receive medical devices that help them perform daily activities and maintain physical function. The legislation mandates that qualifying health benefit plans cover the purchase, fitting, adjustment, repair, and replacement of prosthetic and orthotic devices at a level equal to federal Medicare guidelines. The coverage must include materials, components, and instructions for using the devices, and must enable users to complete daily living activities, perform physical exercises, maximize whole-body health, and improve limb function. The bill prohibits health insurers from discriminating against individuals based on actual or perceived disabilities, requires insurers to provide access to at least two in-state prosthetic providers, and allows for out-of-network provider reimbursement when necessary. Health plan issuers must report annually on their prosthetic and orthotic device coverage, and the state's insurance superintendent will issue public guidance on the care needed to restore full function for individuals with limb differences. The provisions will take effect on January 1, 2027, and apply to health benefit plans issued or renewed after that date.

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https://www.legislature.ohio.gov/legislation/136/hb564