This bill introduces a new section to chapter 48.43 RCW, mandating that nongrandfathered group health plans, excluding small group plans and those for public employees, provide coverage for prosthetic limbs and custom orthotic braces when medically necessary, effective January 1, 2026. The coverage must include one or more prostheses and braces per limb, as well as necessary materials, components, related services, and instruction for use. Additionally, it allows for the repair or replacement of these devices without restrictions on continuous use or useful lifetime, provided certain medical conditions are met.

The bill also stipulates that health plans cannot deny coverage for prosthetic limbs or custom orthotic braces to enrollees with disabilities if similar services would be covered for nondisabled individuals. Health plans may implement standard utilization management and prior authorization practices, but any denial of coverage must be documented in writing. Furthermore, by July 1, 2028, health carriers must report claims data related to these services to the insurance commissioner, who will compile and submit a report to the legislature by December 1, 2028.