This bill amends New Jersey law to require health benefits coverage for an additional orthotic or prosthetic appliance when deemed medically necessary by a physician. Specifically, it mandates that health insurance contracts cover expenses for both a primary orthotic or prosthetic appliance and an additional one necessary for participation in physical and recreational activities, such as running and swimming. The bill also stipulates that reimbursement for these appliances must align with the federal Medicare reimbursement schedule, ensuring equitable financial support for individuals under these health plans.

The legislation aims to expand coverage by requiring health benefits plans—including those from hospital, medical, and health service corporations, as well as various insurers and health maintenance organizations—to provide reimbursement for additional orthotic and prosthetic appliances when medically necessary. This change addresses a gap in current law, which does not cover additional appliances specifically for physical or recreational activities, thereby enhancing access to essential support for individuals engaging in such activities. The provisions of this act will take effect 90 days after enactment and will apply to policies or contracts issued or renewed thereafter.

Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.30, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.13, 17B:27A-19.17, 26:2J-4.31, 52:14-17.29