ASSEMBLY FINANCIAL INSTITUTIONS AND INSURANCE COMMITTEE

STATEMENT TO

ASSEMBLY, No. 3856

with committee amendments

STATE OF NEW JERSEY

DATED:  DECEMBER 9, 2024

      The Assembly Financial Institutions and Insurance Committee reports favorably and with committee amendments Assembly Bill No. 3856.

      As amended, this bill requires health benefits coverage for an additional orthotic and prosthetic appliance under certain circumstances and requires coverage for orthotic and prosthetic appliances obtained through a podiatrist.

      The bill requires health benefits coverage for an additional orthotic or prosthetic appliance from any licensed orthotist or prosthetist, licensed podiatrist, or any certified pedorthist, if the covered person’s physician determines that the additional appliance is necessary to enable the covered person to engage in physical and recreational activities, including running, bicycling, swimming, climbing, skiing, snowboarding, and team and individual sports.  The reimbursement for the additional orthotic or prosthetic appliance is at the same rate as reimbursement for the appliances under the federal Medicare reimbursement schedule.

      Current law requires health benefits coverage for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person's physician, but does not require coverage of an additional appliance for physical or recreational activities, nor does current law require coverage for orthotic and prosthetic appliances obtained through a podiatrist.

      The bill would apply to hospital, medical, and health service corporations; commercial individual, small employer, and larger group insurers; health maintenance organizations; and the State Health Benefits Program and the School Employees’ Health Benefits Program.

      As amended and reported by the committee, Assembly Bill No. 3856 is identical to Senate Bill No. 1439 (1R), which was also reported by the committee on this date.

COMMITTEE AMENDMENTS:

      The committee amended the bill to require health benefits coverage for orthotic or prosthetic appliances obtained from a licensed podiatrist.