Requires health benefits coverage for additional prosthetic appliance under certain circumstances.
Impact
If enacted, the provisions of S3919 will amend existing regulations that currently permit health benefits for only one orthotic or prosthetic appliance in cases deemed medically necessary, excluding those specifically needed for recreational pursuits. By broadening the scope of coverage, the law would significantly impact health plans administered by various organizations including commercial insurers, health maintenance organizations, and state programs. The bill is designed to ensure that individuals requiring additional prosthetic devices for an active lifestyle can receive financial support for such necessities.
Summary
Senate Bill S3919 introduced in New Jersey aims to expand health benefits coverage specifically for orthotic and prosthetic appliances. The bill stipulates that health insurance policies must cover expenses associated with obtaining an additional prosthetic appliance if a physician determines it is necessary for the insured's participation in physical and recreational activities. This includes various sports and physical activities like running, swimming, and skiing. The bill mandates that such coverage should be reimbursed at the same rate as set by the federal Medicare reimbursement schedule.
Contention
While the bill emphasizes inclusiveness and promotes access to aids that support an active lifestyle, there may be concerns regarding costs associated with expanded coverage. Insurance providers might argue that the increase in required reimbursements could lead to higher premiums for all policyholders. Furthermore, there may be discussions on the implications of defining medical necessity in such a way that it encourages broader utilization of orthotic and prosthetic services, prompting deliberation on both financial and ethical fronts.
Prosthetics, Orthotics, and Pedorthics; provider and facility certification by national entity required, continuing education administrative duties required of Alabama Prosthetics and Orthotics Association
Prosthetics, Orthotics, and Pedorthics; national entity certification required to provide care; Department of Workforce required to administer and record
In casualty insurance, providing for reimbursement for custom-fabricated devices, custom-fitted devices, orthosis, orthotics, over-the-counter prostheses, orthoses and pedorthic devices, prefabricated orthoses, prostheses, prosthetics and components of such devices.
Prosthetics, Orthotics, and Pedorthics; national entity certification required to provide care; Department of Workforce required to administer and record