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 stipulates that coverage for replacement or repair of these devices cannot be denied based on continuous use or useful lifetime restrictions if medically necessary due to changes in the patient's condition or the device's condition.

The bill also prohibits health plans from denying coverage for prosthetic limbs or custom orthotic braces to enrollees with disabilities if similar services would be covered for nondisabled individuals. Health plans may apply standard utilization management practices, but any denial of coverage must be documented in writing. Furthermore, the bill requires health plans to provide payment that meets or exceeds federal standards for prosthetic devices and mandates that carriers report claims data to the insurance commissioner by July 1, 2028, for the years 2026 and 2027.