The bill amends the Insurance Company Law of 1921 to include a new section that mandates coverage for various custom-fabricated and custom-fitted medical devices, including orthoses, prostheses, and pedorthic devices, under individual and group health insurance policies. Specifically, it requires that these devices be covered when prescribed by authorized medical professionals, and outlines the responsibilities of practitioners involved in the fitting and provision of these devices. The bill also stipulates that insurers may require preauthorization to determine medical necessity and eligibility for benefits, and it establishes guidelines for the fitting, repair, or replacement of these devices.

Additionally, the bill specifies that reimbursement rates for these devices under Medicaid and contracted insurers will align with the Federal Medicare reimbursement schedule. It defines key terms related to the devices and the professionals involved in their provision, ensuring clarity in the implementation of the coverage requirements. The act will take effect 60 days after its passage, with specific provisions for its application based on the filing of insurance policies.

Statutes/Laws affected:
Printer's No. 1586 (May 05, 2025): P.L.682, No.284