Support Amendment #16 to SB23 (same as HB223 approved unanimously by House Insurance Committee)

Relating to the coverage of orthotics and prosthetics by commercial health insurers

Insured families in need of prosthetic or orthotic devices are facing benefit caps, lifetime benefit caps and sometimes the complete elimination of prosthetic or orthotic device coverage.  The loss of an arm or leg is a catastrophe and should be covered by commercial health insurance.  Other “mandates” often increase utilization which leads to higher premiums; however, no one will cut off their arm or leg to access this benefit.  This amendment eliminates any annual or lifetime caps for orthotic and prosthetic care, other than the annual or lifetime maximums that apply to the health insurance policy in aggregate.

Ø 6 other states have passed this needed legislation; CO, ME, NH, RI, MA, and CA.  8 states, including Texas, are considering similar bills this year and 22 additional states are gearing up to pass this legislation next year.

Ø There is no fiscal implication to the state, and

o there is even a cost savings to the state, according to an analysis done by John S. O’Brien, director, legislative budget board.

The only opposition to this bill comes from the health insurance companies and business organizations who say that premiums will increase as a result of this mandate.  

However, the cost to the health insurance plans is minimal, only 12 cents per member per month ($1.44/year).  

o In addition, the other states that have passed this legislation have not seen any increase in the number of uninsured people due to this legislation.

Ø Amendment #16 will not affect consumer driven plans as defined in statute (chapter 1507 of the insurance code) or commercial health insurance plans covered under ERISA.

Ø This bill treats orthotics and prosthetics just like everything else in the health insurance policy.  There are no “special provisions”.

Ø Orthotics and prosthetics get people back to work!