A bill to amend the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to provide parity under group health plans and group health insurance coverage for the provision of benefits for prosthetics and custom orthotics and benefits for other medical and surgical services.
Insurance Fairness for Amputees Act - Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act to require a group health plan that provides medical and surgical benefits and also provides benefits for prosthetics and custom orthotics to offer such prosthetics and custom orthotics in the same manner as applicable to medical and surgical benefits. Prohibits separate financial requirements or more restrictive treatment limitations. Requires a health plan that does not provide coverage for benefits outside of a network to ensure that such provider network is adequate to ensure enrollee access to prosthetic and custom orthotic devices and related services provided by appropriately credentialed practitioners and accredited suppliers.
Limits coverage for required benefits for prosthetics and custom orthotics to the most appropriate device or component that adequately meets the medical requirements of the patient. Requires benefits to include repair and replacement due to normal wear and tear, irreparable damage, a change in the condition of the patient, or as otherwise determined appropriate by the treating physician.
Prohibits any annual or lifetime dollar limitation on benefits for prosthetics and custom orthotics unless such limitation applies in the aggregate to all benefits.
Directs the Comptroller General to study the effects of the implementation of this Act.
Referred to the Subcommittee on Health, Employment, Labor, and Pensions.
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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