Require Health Benefit Policy Coverage - Orthotic and Prosthetic Devices

If passed, this bill will update the part of the Code of Georgia about insurance.

• Code of Georgia: These are the rules or laws for the state of Georgia that say what people in Georgia can and cannot do.

This bill:

• Makes sure health insurance covers orthotic and prosthetic devices that people need to do their day to day activities 

  • Health Insurance: Health insurance helps pay for doctor visits, medicine, and hospital care. You pay a certain amount, and the insurance company helps cover the rest of the cost when you need medical care.

  • Orthotic and Prosthetic devices: Orthotic devices are special supports, like braces, that help body parts work better. Prosthetic devices are artificial body parts, like a leg or arm, that replace a missing one.

• Limits coverage to three devices per disabled limb per person every three years, unless they need a replacement to stay safe and healthy

• Covers all materials and parts needed to use the devices

• Explains the rules to get a device replaced, including physical changes and breaks that cannot be fixed.

• If passed, health insurance companies can confirm that people really need the devices they are asking insurance to cover, if the devices are less than three years old.

•  Clarifies that insurance paying for these devices will be called “habilitative or rehabilitative benefits”

  • Habilitative or rehabilitative benefits: These are health services that help people learn, keep, or get back skills they need for daily life. 

    • Habilitative benefits help people who never had certain skills,

    • Rehabilitative benefits help people regain skills after an injury or illness, like learning to walk again after breaking a leg.

• Makes sure coverage is similar to other benefits in health insurance policies.

• Sets rules about how many doctors and specialists who provide braces, supports, and artificial body parts have to be available to help people when they need care.

• Allows health insurance companies to offer health insurance plans that give better benefits than the bare minimum that they have to.

If passed, this bill will make insurance companies turn in a report by July 1, 2032, on how this coverage is being put in place to the state leaders that are in charge of making sure these changes to the rules are working 

If this bill becomes law, it gets rid of any other laws that could stop this one from working.