Requires health benefits coverage for additional orthotic and prosthetic appliances under certain circumstances; requires coverage for orthotic and prosthetic appliances obtained through podiatrists.*

More brace and prosthetic coverage for patients

Beginning October 6, 2025, covered New Jersey health plans must cover braces and prosthetic devices a physician finds medically necessary. They must also cover a second device when a physician finds it necessary for running, bicycling, swimming, climbing, skiing, snowboarding, or team or individual sports. Devices must come from licensed orthotists, prosthetists, or podiatrists, or certified pedorthists. Plans must pay Medicare reimbursement rates and cover these benefits on the same basis as other medical conditions. The law covers HMOs, State Health Benefits Program contracts, and specified individual, group, small-employer, and health service plans. It applies to policies and agreements delivered, issued, executed, or renewed from that date, and state program contracts purchased from that date. For affected insurance and service contracts, the insurer must have reserved the right to change premiums; for HMO agreements, charges. HMOs must provide these benefits to obtain or keep their state operating approval.