WA SB5629

Nongrandfathered group health plans (excluding small group and public employee plans) issued or renewed on or after January 1, 2026, must cover one or more prosthetic limbs and custom orthotic braces per limb when medically necessary for daily living, job-related activities, or physical activities like running, swimming, and strength training

Coverage must include materials, components, related services, enrollee instruction, and reasonable repair or replacement of devices without continuous use or useful lifetime restrictions when medically necessary

Replacement or repair is covered when repair costs exceed 60% of replacement cost, when the device condition changes irreparably, or when the patient's physiological condition changes; confirmation from the prescribing provider may be required if the device is less than three years old

Health plans cannot deny coverage for prosthetic limbs or custom orthotic braces for enrollees with disabilities if similar services would be covered for nondisabled persons seeking to restore the same physical function

Carriers must report claims data to the Office of the Insurance Commissioner by July 1, 2028, covering plan years 2026 and 2027, with a legislative report due by December 1, 2028