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Prosthetic Parity Act 5615 


 
The Prosthetic Parity Act (HR 5615) aims to guarantee amputees reasonable coverage forprosthetics under employer-funded and group health plans. The bill must travel through several levels of approval before being considered in the Senate and the Amputee Coalition of America (ACA) is working hard to obtain a hearing date, to increase sponsorship of the bill and to raise general awareness.

The Prosthetic Parity Act (HR 5615) is as follows: Group Health Plan ProstheticsParity Act of 2007 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan that provides both medical and surgical benefits and benefits for prosthetic devices and components to provide prosthetics coverage under terms and conditions that are no less favorable than those applicable to substantially all medical and surgical benefits provided under the plan. Prohibits the prosthetics benefit from being subject to separate or more restrictive financial requirements or more restrictive treatment limitations. Applies the requirements of this Act separately with respect to in-network and out-of-network benefits. Requires a group health plan to apply the same prior authorization requirements to the prosthetics benefit as apply for all similar benefits under the plan. Limits the required prosthetics benefit to the most appropriate model that adequately meets the medical requirements of the patient. Includes repair or replacement of prosthetic devices and components within such coverage. Prohibits a group health plan from imposing any annual or lifetime dollar limitation on the prosthetics benefit that is not applied in the aggregate to all medical and surgical benefits provided under the plan. Requires the Secretary of Labor to:

(1) assist participants and beneficiaries with any questions or problems regarding compliance with the requirements of this Act; and

(2) conduct random audits of group health plans to ensure compliance. Requires the Comptroller General to evaluate the effects of this Act, including on the cost of and access to heath insurance coverage.



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