SB 408 — relative to health insurance coverage for prosthetics.

CHAPTER 244 SB 408-FN - VERSIONFINAL ADOPTEDVERSION BY BOTH BODIES 03/12/2026 1049s 23Apr2026...

Health and Human Services ───────────────────────────────────────────────────────────────── ANALYSIS This bill requires health insurance policies to provide coverage for adult prosthetics, including activity-specificactivity- specific prosthetic devices.

CHAPTER 244 SB 408-FN - VERSIONFINAL ADOPTEDVERSION BY BOTH BODIES 03/12/2026 1049s 23Apr2026...

1244:1 Accident and Health Insurance;

The insurer may limit coverage for activity-activity-specific specific prosthetic devices to one activity-specific prosthetic device per plan yeaMedicallyyear. necessary prosthetic devices shall not be subject to any annual limits.

Medically necessary prosthetic devices shall not be subject to any annual limits.

The insurer may limit coverage for activity-specific prosthetic devices to one activity-specificactivity- specific prosthetic device every 5 years and may apply utilization management, including limiting or excluding coverage if the covered person has received an activity-specific device in the last 5 years.

SB 408-FN - VERSION ADOPTED BY BOTH BODIES - Page 2 - (b) "Activity-specific prosthetic device" means a prosthetic device designed to allow an individual to participate in a specific activity that could damage the residual limb or everyday prosthesis, or when the everyday prosthesis would not function effectively to perform that specified activity.

CHAPTER 244 SB 408-FN - FINAL VERSION - Page 2 - [III.] V.

2244:2 Coverage for Certain Prosthetic Devices.

3244:3 Effective Date.

LBAApproved: 26-2038 5/1/26 SB 408-FN- FISCAL NOTE AS AMENDED BY THE HOUSE (AMENDMENT # 2026-1505h) AN ACT relative to health insurance coverage for prosthetics.  FISCAL IMPACT:

EstimatedJuly State02, Impact FY 2026 FYEffective 2027Date: FY 2028 FY 2029 Revenue $0 $0 Indeterminable Indeterminable Increase Increase Revenue Fund(s) General Fund - Insurance Premium Tax Indeterminable Indeterminable Increase Increase Expenditures* $0 $0 (State Employee (State Employee Health Benefit Health Benefit Plan) Plan) Funding Source(s) General Fund, Highway Fund, and Various Agency Funds Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill Estimated Political Subdivision Impact FY 2026 FY 2027 FY 2028 FY 2029 County Revenue $0 $0 $0 $0 County Expenditures $0 $0 Indeterminable Indeterminable Increase Increase Local Revenue $0 $0 $0 $0 Local Expenditures $0 $0 Indeterminable Indeterminable Increase Increase METHODOLOGY:

ThisJanuary bill01, requires2028 health insurance policies to provide coverage for prosthetic devices, including activity-specific prosthetic devices, for individuals over 19 years of age and children under 19 years of age.

The bill allows insurers to limit coverage for activity-specific prosthetic devices to one device per plan year for children and one device every 5 years for adults and applies to the state employee health benefit plan.

The bill takes effect January 1, 2028.

The Insurance Department states this bill amends RSA 415:18-ff to mandate coverage for prosthetic devices, including activity-specific devices, for individuals under 19 years of age and expands coverage to individuals over 19 years of age.

The Department anticipates an increase in claims costs related to prosthetic devices, estimated at approximately $27,000 per beneficiary.

The bill restricts coverage for a second, activity-specific prosthesis to one unit for every five-year period, per covered life.

Based on information from the CDC on the number of individuals living with limb loss nationally, the Department estimates the eligible New Hampshire population is about 19,800 individuals.

However, only approximately 45% of NH residents hold membership in commercial, fully-insured health insurance plans which, if this proposal is enacted, would define the eligible population.

Consequently, approximately 8,900 adults would be in the eligible population affected by limb loss.

The Department assumes that only 10 to 30 percent of this eligible population would take up this benefit if it is enacted.

The Department estimates the annualized fiscal impact may be in the range of $4 to $12 million.

Any increase in health insurance premiums due to the expanded coverage would result in a corresponding increase in Insurance Premium Tax revenue for the State.

The Department of Administrative Services states the bill applies to the State Employee Health Benefit Plan and estimates claims costs could increase by more than $100,000 to $500,000 annually.

Due to variability in utilization rates, the Department indicates the actual fiscal impact on the State Employee Health Benefit Plan is indeterminable but expected to fall within this range.

The State would also incur administrative costs associated with implementing the bill through its third-party medical administrator.

Local and county governments that purchase health insurance for their employees may experience increased premiums due to the expanded coverage for prosthetic devices.

The extent of this impact will depend on the number of employees requiring such devices and the associated claims costs.

AGENCIES CONTACTED:

Insurance Department and Department of Administrative Services