House Bill 906, titled "Reagan's Law," would require most health benefit plans offered in North Carolina to cover prosthetic and orthotic devices and related care for people with limb loss or limb difference. The bill ties required coverage to the types of devices and services that federal law and Medicare Part B require, and it expressly includes materials, components, instruction on use, repair, and replacement. It also requires coverage for the prosthetic or orthotic device that the insured's healthcare provider determines is most appropriate to meet medical needs for daily living or essential job-related activities.
The bill goes further by prohibiting plans from limiting coverage to only one device. It would require coverage for additional devices when medically appropriate, including devices used for physical activities such as running, biking, swimming, and strength training, as well as devices intended to maximize whole-body health and function. The bill also treats this coverage as a habilitative or rehabilitative benefit for purposes of essential health benefits requirements, and bars insurers from denying claims for prosthetic or orthotic devices in situations where a comparable service would be covered for a person without a disability.
HB906 also sets replacement rules for prosthetic and orthotic devices. Coverage for replacement would not be subject to continuous-use or useful-lifetime limits if the prescribing provider determines replacement is necessary because of a change in the patient's condition, irreparable damage to the device, or repair costs exceeding 60% of replacement cost. For devices less than three years old, an insurer may require provider confirmation before replacement. The bill also requires coverage for custom devices in replacement situations.
In addition to the coverage mandate, the bill creates a reporting requirement. By February 1, 2028, insurers offering plans subject to the new section must report the number and total amount of claims paid for these benefits to the Department of Insurance, and the Commissioner must then aggregate the data and report it to legislative oversight committees by March 1, 2028. The act would take effect October 1, 2025, and apply to policies issued, renewed, or amended on or after that date, or at the next annual renewal after that date.
The available legislative history shows no recorded votes or committee transcript debate, so the overall sentiment appears neutral to favorable based on the bill's advancement and its framing as an access-to-care measure. The main policy issue likely to draw attention is the cost and scope of mandated coverage for insurers, especially the requirement to cover multiple devices, athletic/recreational prosthetics, and replacements without strict lifetime limits. Supporters are likely to view the bill as expanding access, mobility, and quality of life for people with limb loss, while opponents or cost-conscious stakeholders may focus on premium impacts and administrative burden.
HB906 would amend Chapter 58 of the North Carolina General Statutes by adding a new insurance coverage mandate for prosthetic and orthotic devices and related care. It would apply broadly to health benefit plans in the state, with specified exclusions for certain small employer and multiple employer arrangements, and would require insurers to cover medically necessary devices, accessories, instruction, repairs, replacements, and custom devices under the standards described in the bill. It also creates new insurer reporting duties and a Department of Insurance aggregation and legislative reporting requirement, while setting an effective date and applicability rules for policy renewals and amendments.
There is no recorded committee transcript or vote data in the provided history, but the bill's movement and title suggest generally favorable treatment. The measure is framed as improving access for North Carolinians with limb loss and limb difference, which indicates a supportive policy intent. Any opposition is not documented in the provided materials, though the bill's insurance mandate could prompt cost-related concerns from insurers or other stakeholders.
The most likely points of contention are the breadth of the required coverage and the potential cost to health plans. In particular, the bill requires coverage for more than one prosthetic or orthotic device, includes devices for athletic and recreational activities, and limits insurers' ability to rely on lifetime-use restrictions when replacement is medically necessary. Insurers and employer-plan stakeholders may question premium impacts, utilization controls, and administrative complexity, while disability advocates and medical providers are likely to support the expanded access and provider-directed medical necessity standard.