HB 76 Summary

• Requires health insurance policies delivered, issued, or renewed on or after January 1, 2012 to cover orthotic and prosthetic devices at reimbursement rates equal to federal Medicare rates under 42 U.S.C. sections 1395k, 1395l, and 1395m.

• Applies to individual health insurance contracts and group/blanket health insurance policies that provide physician office coverage or major medical/comprehensive coverage.

• Defines orthoses as custom fabricated braces and prostheses as artificial limbs replacing missing external body parts, excluding items like artificial eyes, ears, dental appliances, and ostomy products.

• Permits insurers to require prior authorization for orthotic and prosthetic devices and to limit coverage to the most appropriate model determined by the treating physician.

• Excludes limited benefit policies including hospital confinement indemnity, disability income, accident-only, long-term care, Medicare supplement, and specified disease indemnity policies.

• Covers repair and replacement of orthotic and prosthetic devices subject to co-payments and deductibles, except when necessitated by misuse or loss.