The bill has implications for health insurance providers in Illinois, as it requires them to adjust their policies to include comprehensive coverage of medically necessary prosthetic and orthotic devices. This could lead to increased access for individuals requiring these devices, thereby potentially improving their quality of life. Moreover, it clarifies that the coverage mandated by the bill does not add any financial burden to the state in terms of essential health benefits under federal law, thus maintaining financial stability for the state while enhancing healthcare accessibility.
Summary
House Bill 3036 amends the Accident and Health Article of the Illinois Insurance Code, specifically addressing the coverage of prosthetic and custom orthotic devices for enrollees at any age. This bill mandates that health insurance policies in Illinois provide benefits for prosthetic or custom orthotic devices that are deemed necessary by the enrollee's provider, ensuring that these devices support the enrollee’s ability to engage in physical activities like running, biking, swimming, and lifting weights. This aim is to maximize overall health and enhance limb function for individuals who require such devices.
Contention
Notable points of contention surrounding this bill may arise regarding its implementation and the specifications of what constitutes a 'medically necessary' device. Insurers may have concerns about the cost implications and the scope of coverage they are required to provide. Stakeholders may also debate over the definitions of 'appropriate model' and what limits, if any, should exist on the types of devices covered under this mandate. Furthermore, ensuring that providers offer services consistent with the mandate while maintaining the quality of care will also be a focus in discussions about this bill.
To create orthotics and prosthetics parity and ensure coverage of orthotics and prosthetics for the performance of physical activities for children 18 years of age and younger.