This bill expands health benefits coverage to include an additional orthotic or prosthetic appliance when deemed necessary by a physician for participation in physical and recreational activities, such as running, swimming, or skiing. It specifies that these appliances must be sourced from licensed orthotists, prosthetists, or certified pedorthists, and establishes that reimbursement for these appliances will follow the federal Medicare reimbursement schedule. The bill amends existing laws governing various health service entities, ensuring consistent coverage across hospital service corporations, medical service corporations, health maintenance organizations, and individual and group health insurance policies.

Previously, the law only mandated coverage for orthotic and prosthetic appliances deemed medically necessary, excluding additional appliances for non-medical purposes. This bill clarifies definitions related to "orthotic appliance," "prosthetic appliance," and the qualifications of providers, thereby broadening the scope of coverage. The provisions 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