AB 331

This bill requires a health care plan that covers hospital, medical, or surgical

expenses to cover the cost of orthotic devices and prosthetic devices that are

prescribed by a physician as medically necessary. Orthotic devices are defined under

the bill, generally, as rigid or semirigid devices that are used to support, restrain,

limit, correct, or enhance motion in a weak or deformed human body part. Prosthetic

devices are defined as replacements for an external human body part in whole or in

part. Besides covering the devices, a health care plan must cover services and

supplies relating to the devices and the repair or replacement of the devices.

Additionally, a defined network plan must ensure that covered orthotic and

prosthetic services may be obtained from at least two different providers of orthotic

devices and at least two different providers of prosthetic devices that are located

within a reasonable travel distance or time, defined as 60 miles or less or 60 minutes

or less. If a defined network plan does not have at least two different providers of

orthotic devices and at least two different providers of prosthetic devices in its

provider network, it must cover the services of a provider outside its network that

is located within a reasonable travel distance or time, at no additional cost to an

insured under the plan, to ensure that insureds under the plan have a choice of at

least two different providers of orthotic devices and at least two different providers

of prosthetic devices.

The coverage requirement applies to both individual and group health

insurance policies and plans, including health care plans offered by the state, a

municipality, or a school district. The coverage may not be subject to any limitations,

exclusions, or cost-sharing provisions that are greater than those that apply

generally under the policy or plan.