This bill amends current health insurance laws to expand coverage for prosthetic devices to include adults over the age of 19, in addition to the existing coverage for children under 19. Specifically, it requires insurers to provide coverage for medically necessary prosthetic devices, including activity-specific prosthetic devices, for all residents of the state, regardless of age. The bill allows insurers to limit coverage for activity-specific prosthetic devices to one device every five years for adults, while ensuring that medically necessary devices are not subject to annual limits. The language in the bill deletes the previous specification of coverage being limited to children and introduces new provisions for adult coverage.

Additionally, the bill clarifies that covered benefits will include all necessary materials and components for the prosthetic device, instruction on its use, and repair or replacement when deemed medically necessary. It also specifies that this section does not apply to plans available through the Small Business Health Options Program (SHOP). The effective date for this expanded coverage is set for January 1, 2026. The fiscal impact of the bill is expected to result in increased claims costs for insurers, with estimates suggesting an annualized impact of $4 to $12 million, depending on the uptake of the benefit by eligible individuals.

Statutes affected:
Introduced: 415:18-ff, 415:18-n
As Amended by the Senate: 415:18-ff, 415:18-n