HB 2094 Summary

• Requires health insurance contracts (HMOs, disability insurance, and group disability insurance policies) to provide coverage for prosthetic and orthotic devices equivalent to Medicare coverage under Title XVIII of the Social Security Act.

• Mandates coverage for the most appropriate device determined medically necessary by a treating physician, including all services and supplies needed for design, fabrication, fitting, instruction, repair, and replacement of prosthetic and orthotic devices.

• Prohibits insurers from imposing different deductibles, copayments, coinsurance, benefit maximums, waiting periods, or coverage limitations on prosthetic and orthotic devices compared to other medical or surgical benefits.

• Requires reimbursement rates at least equivalent to Medicare rates and comparable to reimbursement for restorative internal devices.

• Exempts limited benefit coverage plans from these requirements.