HB 89 - Requiring Insurance Coverage of Prosthetic Devices - Utah Key Vote

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Title: Requiring Insurance Coverage of Prosthetic Devices

Vote Smart's Synopsis:

Vote to pass a bill requires health insurance companies to provide coverage for prosthetic devices beginning July 1, 2009.

Highlights:

- Requires the coverage to be at least equal to the coverage provided by Medicare, which is 80 percent of the payment (Sec. 1). - Requires the coverage to include all materials, components, services, and supplies necessary for the effective use of a prosthetic devices, including (Sec. 1):

    - Formulating its design; - Fabrication; - Material and Component selection; - Measurements and fittings; - Static and dynamic alignments; and - Instructing patients in the use of the device.
- Requires the coverage to include the repair or replacement of a prosthetic device that is considered medically necessary to restore or maintain the ability to complete day-to-day activities or essential job related activities, provided that it is not solely for comfort or convenience (Sec. 1). - Authorizes companies to impose co-payments or coinsurance amounts on prosthetic devices, provided that they do not exceed the amounts imposed under Part B of the Medicare fee-for-service program (Sec. 1). - Specifies that coverage may be subject to cost-sharing provisions, including dollar limits, deductibles, and coinsurance that are not less favorable to the insured than the cost-sharing provisions of the health benefit plan that apply to physical illness (Sec. 1). - Specifies that prosthetic devices do not include orthotic devices (Sec. 1). - Specifies that patients receiving care through a managed care plan or preferred provider plan shall have access to medically necessary clinical care, prosthetic devices, and technology from at least two providers within their care network (Sec. 1).

Title: Requiring Insurance Coverage of Prosthetic Devices

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