1. A. Any of the following practices with respect to a health benefits plan are defined as unfair and deceptive practices and are prohibited:

   1. (1) canceling or changing the premiums, benefits or conditions of a health benefits plan on the basis of an insured's actual or perceived disability;
   2. (2) denying a prosthetic device, a custom orthotic device or a complex rehabilitation technology device benefit for a person with limb loss, limb absence or mobility limitation that would otherwise be covered for a non-disabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity;
   3. (3) failure to apply the most recent version of treatment and fit criteria developed by the professional association with the most relevant clinical specialty when performing a utilization review for a request for coverage of prosthetic device, custom orthotic device or complex rehabilitation technology device benefits; and
   4. (4) failure to apply medical necessity review standards developed by the professional association with the most relevant clinical specialty when conducting utilization management review or processing appeals regarding benefit denial.

2. B. For purposes of this section:

   1. (1) "complex rehabilitation technology device" means a subset of durable medical equipment that:

      1. (a) consists of complex rehabilitation manual and power wheelchairs and mobility devices, including specialized seating and positioning items, options and accessories;
      2. (b) is designed, manufactured, configured, adjusted or modified for a specific person to meet that person's unique medical, physical, functional and environmental needs and capacities;
      3. (c) is generally not useful to a person in the absence of a disability, illness, injury or other medical condition; and
      4. (d) requires specialized services to ensure appropriate use of the item, including: 1) an evaluation of the features and functions necessary to assist the person who will use the device; or 2) configuring, fitting, programming, adjusting or adapting the particular device for use by a person; and

   2. (2) "health benefits plan" means a policy or agreement entered into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse the costs of health care services; provided that "health benefits plan" does not include the following:

      1. (a) an accident-only policy;
      2. (b) a credit-only policy;
      3. (c) a long- or short-term care or disability income policy;
      4. (d) a specified disease policy;
      5. (e) coverage provided pursuant to Title 18 of the federal Social Security Act, as amended;
      6. (f) coverage provided pursuant to Title 19 of the federal Social Security Act and the Public Assistance Act;
      7. (g) a federal TRICARE policy, including a federal civilian health and medical program of the uniformed services supplement;
      8. (h) a fixed or hospital indemnity policy;
      9. (i) a dental-only policy;
      10. (j) a vision-only policy;
      11. (k) a workers' compensation policy;
      12. (l) an automobile medical payment policy; or
      13. (m) any other policy specified in rules of the superintendent.

History: Laws 2023, ch. 196, § 2; 2026, ch. 41, § 2.

ANNOTATIONS

The 2026 amendment, effective May 20, 2026, provided that the denial of a complex rehabilitation technology device with respect to a health benefits plan is an unfair and deceptive practice in certain circumstances; in Subsection A, Paragraph A(2), after "denying a prosthetic" deleted "or" and added "device, a custom", after "orthotic" added "device or a complex rehabilitation technology device", and after "benefit for" deleted "an individual with limb loss or absence" and added "a person with limb loss, limb absence or mobility limitation", in Paragraph A(3), after "coverage of prosthetic" deleted "or" and added "device, custom", and after "orthotic" added "device or complex rehabilitation technology device"; and in Subsection B, added new Paragraph B(1) and new paragraph designation "(2)", in Paragraph B(2), redesignated former Paragraphs B(1) through B(13) as Subparagraphs B(2)(a) through B(2)(m), respectively.

Applicability. — Laws 2026, ch. 41, § 7 provided that the provisions of Laws 2026, ch. 41 apply to policies, plans, contracts and certificates delivered or issued for delivery or renewed, extended or amended in this state on or after January 1, 2027.