The proposed bill introduces a new section to chapter 48.43 RCW, mandating that large group health plans, excluding those for public employees and their dependents, provide coverage for prosthetic limbs and custom orthotic braces when deemed medically necessary. Effective January 1, 2026, the coverage must include one or more prostheses and custom orthotic braces per limb, facilitating activities of daily living, job-related tasks, and physical activities such as running and swimming. Additionally, the bill stipulates that coverage must encompass necessary materials, components, related services, and instruction for the use of these devices, as well as reasonable repair or replacement without restrictions based on continuous use or useful lifetime, provided certain medical conditions are met.

Furthermore, the bill prohibits health plans from denying coverage for prosthetic limbs or custom orthotic braces to individuals with disabilities if similar services would be covered for nondisabled individuals. It allows health plans to implement standard utilization management and prior authorization practices, requiring written explanations for any coverage denials. The bill also mandates that health plans provide payment equal to federal standards for prosthetic devices and requires carriers to report claims data to the insurance commissioner by July 1, 2028, with a summary report due to the legislature by December 1, 2028. Definitions for "prosthetic limb" and "custom orthotic brace" are also included to clarify the scope of the coverage.