AN ACT relating to coverage for prostheses and orthoses.

Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prostheses and orthoses; establish minimum requirements for the required coverage; require utilizations review decisions to be made in a nondiscriminatory manner; require an insurer or its private review agent to provide notice of certain rights of the insured; establish notice requirements for denials; establish network adequacy requirements for the provision of a prosthesis or orthosis…

Health Benefit Plan Mandate Local Mandate State Employee Health Plan Mandate Disabilities Education, Higher Effective Dates, Delayed Health and Medical Services Health Care Professionals Insurance, Health Reports Mandated State Employees Actuarial Analysis

Effective date: set within the act

This act specifies its own effective date(s) for some or all of its sections instead of following the standard 90-day rule (Ky. Constitution § 55). See the act text for the exact dates.

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Plain-language summary

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This bill requires health insurance plans in Kentucky to cover prosthetic limbs and orthotic devices, such as braces and supports, starting January 1, 2027. It sets minimum standards for that coverage, requires fair and nondiscriminatory review of coverage requests, and ensures patients are informed of their rights when a claim is denied. The law also applies to health plans for state employees and employees of public colleges and universities. Who it may affect: Kentuckians with limb loss or physical disabilities who use prostheses or orthoses, state government employees, and employees of public postsecondary institutions.

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