HB 23-1136

House Bill 23-1136, which has been approved by the governor and is now law, requires health insurance companies in Colorado to cover additional prosthetic devices if a doctor says they are needed for physical or recreational activities. This new coverage will start applying to large employer plans from January 1, 2025, and to individual and small group plans after federal approval or confirmation that the state can cover these costs without violating federal health benefit rules. If there's no response from the federal government within a year, the requirement will automatically apply to all relevant insurance plans starting in 2025. This means people with prosthetic needs for recreational activities could get better coverage and support from their insurance providers.

Official Summary

For the purposes of health insurance coverage for a prosthetic device (device), the act requires a health insurance carrier to provide coverage for an additional device or devices if the covered person's treating physician determines that the additional device or devices are necessary for the covered person to engage in physical and recreational activities. The required coverage applies to large employer plans issued or renewed on or after January 1, 2025. For individual and small group plans, the act requires the division of insurance (division) to make a determination as to whether the required coverage for a prosthetic device or devices is in addition to essential health benefits that requires the state to defray the costs of the required coverage and to submit the determination to the federal department of health and human services (federal department) for confirmation of the division's determination. If the federal department confirms that the required coverage is not in addition to essential health benefits or fails to respond within 365 days after the division submitted the request, the required coverage applies to individual and small group plans issued or renewed on or after January 1, 2025. APPROVED by Governor May 25, 2023 EFFECTIVE August 7, 2023 NOTE: This act was passed without a safety clause and takes effect 90 days after sine die.(Note: This summary applies to this bill as enacted.)

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