SB 97 requires Kentucky health benefit plans to cover prostheses and orthoses, and it defines that mandate broadly to include short-term limited-duration coverage and student health insurance offered through Kentucky-licensed insurers. The bill sets minimum coverage standards tied to federal Medicare-related prosthetics and orthotics rules, and then expands coverage to devices prescribed by a health care provider and selected by a licensed prosthetist or orthotist as medically appropriate for daily living, work, exercise, bathing, and overall limb function. It also requires coverage for materials, components, instruction, repairs, and replacements when medically necessary, and limits the use of restrictive cost-sharing and utilization review practices that would deny coverage solely because of disability.
The bill also addresses network adequacy and insurer reporting. If a plan uses a network for prosthetic and orthotic services, the network must be reasonably accessible and include at least two licensed prosthetists/orthotists in Kentucky; if in-network care is unavailable, the insurer must provide an out-of-network referral process and reimburse at a mutually agreed rate while applying in-network cost sharing. Insurers must file annual reports on claims received and paid, and the Department of Insurance must aggregate and report the data to the legislature. The bill applies these new requirements not only to general health benefit plans but also to state postsecondary institution employee plans and the state employee health insurance program by cross-referencing Section 1 in those statutes.
Beyond the prosthetics mandate, SB 97 makes conforming changes to Kentucky’s public employee and postsecondary institution health insurance statutes so those plans must comply with the new coverage rules. It preserves existing provisions on special enrollment for pregnant women, hearing aid coverage for children, autism coverage, amino acid-based formula coverage, and other public employee plan requirements already in law. The bill takes effect January 1, 2027, and applies to plans issued or renewed on or after that date.
The overall sentiment around the bill appears strongly favorable and largely noncontroversial. The recorded votes were unanimous in the Senate and House, including a unanimous House veto override, indicating broad bipartisan support. No committee transcript was provided, but the voting history suggests the measure was viewed as a patient-protection and insurance-coverage expansion bill with little organized opposition on the floor.
The main points of potential contention are the scope and cost of the mandate. Insurers may be concerned about expanded coverage obligations, replacement standards without strict lifetime limits, network adequacy requirements, and the prohibition on disability-based denials. Public employers and plan administrators could also focus on premium impacts and administrative compliance, especially because the bill extends to state employee and postsecondary institution plans. However, the unanimous votes suggest any such concerns did not generate significant legislative resistance.
SB 97 creates a new insurance coverage mandate in KRS Chapter 304 requiring health benefit plans to cover prostheses and orthoses and sets detailed standards for medical necessity, replacement, repairs, cost sharing, network access, and reporting. It also amends KRS 164.2871 and KRS 18A.225 to incorporate the new prosthetics and orthotics requirements into state postsecondary institution employee plans and the state employee health insurance program, thereby extending the mandate to public-sector coverage arrangements. The act applies to policies issued or renewed on or after January 1, 2027.
The bill appears to have enjoyed broad, bipartisan support and little visible opposition. It passed the Senate and House unanimously and later passed a unanimous House veto override, suggesting strong consensus that the measure expands medically necessary coverage for people with limb loss or impairment. The absence of recorded dissent in the votes indicates the bill was generally viewed positively as a consumer and disability-access measure.
The likely areas of contention are not reflected in the floor votes but are inherent in the bill’s design: insurers may object to the breadth of the coverage mandate, the requirement to cover multiple devices and replacements based on medical need rather than strict utilization limits, and the network adequacy and out-of-network reimbursement rules. Public employers and plan sponsors could also be concerned about increased costs and administrative complexity. On the other hand, disability advocates and patient groups would likely support the bill’s anti-discrimination protections, broader functional coverage standards, and limits on denial practices.