HB 1033 Summary

• Creates requirements for individual, group, blanket, franchise, and managed care health insurance policies issued on or after July 1, 2016 to evaluate and review coverage for orthotics, prosthetics, orthoses, and prostheses based on federal Medicare standards under 42 U.S.C. sections 1395k, 1395l, and 1395m

• Allows insurers to require prior authorization for orthotics and prosthetics in the same manner as other covered benefits, and limits coverage to the most appropriate model that meets the patient's medical needs as determined by the treating physician

• Permits insurers to require that benefits be provided only by licensed orthotists or prosthetists and by approved vendors; includes coverage for repair and replacement unless caused by misuse or loss

• Allows group health plans and health maintenance organizations to offer optional coverage without deductible or coinsurance provisions for an appropriate additional premium

• Exempts hospital confinement indemnity, disability income, accident-only, long-term care, Medicare supplement, limited benefit health, and specified disease indemnity policies from these requirements; effective July 1, 2016