Washington SB5629 mandates health plans to cover prosthetic limbs and custom orthotic braces for medically necessary use.

Washington SB5629 requires health plans to cover prosthetic limbs and custom orthotic braces for enrollees needing them to perform daily activities or physical therapy. The coverage includes materials, instruction, and repairs. Health plans can apply normal utilization management practices but must provide written explanations for any denials. The bill also mandates carriers to report claims data to the insurance commissioner by July 1, 2028.

Washington SB5629 mandates health plans to cover prosthetic limbs and custom orthotic braces for medically necessary use.

Washington SB5629 requires health plans to cover prosthetic limbs and custom orthotic braces for enrollees needing them to perform daily activities or physical therapy. The coverage includes materials, instruction, and repairs. Health plans can apply normal utilization management practices but must provide written explanations for any denials. The bill also mandates carriers to report claims data to the insurance commissioner by July 1, 2028.