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. Health plans cannot deny coverage for individuals with disabilities if similar services would be covered for nondisabled individuals.

Furthermore, the bill stipulates that health plans must adhere to federal payment standards for prosthetic limbs and custom orthotic braces. By July 1, 2028, insurance carriers are required to report the number and total amount of claims paid for these services for the years 2026 and 2027. The bill defines "prosthetic limb" and "custom orthotic brace" to clarify the types of devices covered, ensuring that individuals with mobility impairments receive necessary support for their functional mobility.