HB204 Alabama 2019 Session

Summary

Primary Sponsor

Ron Johnson

Republican

Session

Regular Session 2019

Title

Prosthetic and orthotic devices, health benefit plans, coverage the same as Medicare, coverage under health care service plans and health maint. organizations, Secs. 10A-20-6.16, 27-21A-23 am'd.

Summary

HB 204 would require health benefit plans in Alabama to cover custom prosthetic and orthotic devices at Medicare-equivalent levels, with related services and protections for patients.

What This Bill Does

If enacted, health benefit plans must cover custom prosthetic and orthotic devices that a physician medically determines are necessary to restore function, at terms at least as favorable as Medicare. The coverage includes all services needed to use the device, such as design, fabrication, fittings, alignments, and patient instruction. Reimbursement must be at least Medicare-equivalent and not more restrictive than other medical benefits, and it must cover repairs or replacements when medically necessary. The law also prevents plans from imposing separate or higher financial requirements for these benefits, allows copays/coinsurance only if not more restrictive than medical benefits, and requires in-network access rules (two in-state providers) for managed care plans; public employee plans would be included after December 31, 2020. The act becomes effective October 1, 2019.

Who It Affects

• Individuals enrolled in health benefit plans who need prosthetic or orthotic devices, who would receive coverage that is Medicare-equivalent and includes necessary services.
• Health insurers, HMOs, and other health plans operating in Alabama, which must adjust coverage rules, payments, and networks to meet the new requirements (including expansion to certain public employee plans after 2020).

Key Provisions

• Defines Health Benefit Plan, Orthotic Device, and Prosthetic Device for the purposes of the bill.
• Requires coverage for custom prosthetic and orthotic devices at least equivalent to Medicare and no less favorable than medical/surgical benefits; covers all medically necessary services to use the device.
• Sets reimbursement to at least Medicare-equivalent and not more restrictive than other plan benefits; covers repairs or replacements when medically necessary.
• Prohibits separate or more restrictive financial requirements for these benefits; allows copay/coinsurance but not more restrictive than medical benefits; out-of-network terms must not be more restrictive than out-of-network medical benefits.
• Allows limiting or altering out-of-network coverage, but not more restrictive than out-of-network medical benefit rules.
• Requires in-network access to at least two distinct prosthetic/orthotic providers in-state for managed care plans.
• No annual or lifetime maximum specifically for prosthetic/orthotic devices beyond aggregate policy limits.
• Public employee plans become subject to these requirements after December 31, 2020; the act takes effect October 1, 2019.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health