---
title: SB 265. Insurance; health benefit policy coverage for medically necessary orthotic devices and prosthetic devices; require
collection: bills
id: 2025-2026/sb265
cite_as: SB 265, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/sb265
md_url: https://georgiacommons.org/bills/2025-2026/sb265.md
text_url: https://georgiacommons.org/bills/2025-2026/sb265/text
source_url: https://www.legis.ga.gov/legislation/70862
date: 2025-02-27
status: introduced
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 95
omitted_url: https://georgiacommons.org/bills/2025-2026/sb265.md?full=1
bill_number: SB 265
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: Senate
bill_type: bill
status_date: 2025-02-26
last_action: Senate Read and Referred
sponsors:
- Shawn Still
- Ben Watson
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/SB265/2025
upstream_id: 1986150
summaries_model: claude-sonnet-5
topic_tags:
- health insurance coverage
- prosthetic devices
- orthotic devices
- disability accommodations
- insurance regulation
---
# SB 265. Insurance; health benefit policy coverage for medically necessary orthotic devices and prosthetic devices; require
## Text
Senate Bill 265
By: Senators Still of the 48th and Watson of the 1st
A BILL TO BE ENTITLED
AN ACT
To amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to
require health benefit policy coverage for medically necessary orthotic devices and prosthetic
devices and their materials and components; to provide for definitions; to provide for
requirements; to provide for reporting; to provide for rules and regulations; to provide for
related matters; to provide for an effective date and appropriations; to repeal conflicting laws;
and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Title 33 of the Official Code of Georgia Annotated, relating to insurance, is amended in
Chapter 24, relating to insurance generally, by adding a new Code section to read as follows:
"33-24-59.34.
(a) As used in this Code section, the term:
(1) 'Cost-sharing requirement' shall have the same meaning as set forth in Code
Section 33-24-59.32.
(2) 'Covered person' means an individual covered under a health benefit policy.
(3) 'Health benefit policy' shall have the same meaning as set forth in Code
Section 33-24-59.21.
(4) 'Health insurer' means any person, corporation, or other entity authorized to provide
health benefit policies under this title.
(5) 'Medically necessary' shall have the same meaning as set forth in Code
Section 33-46-4 and shall be in accordance with nationally recognized clinical practice
guidelines.
(6) 'Nationally recognized clinical practice guidelines' means evidence based clinical
practice guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with a conflict
of interest policy. Such guidelines establish standards of care informed by a systematic
review of evidence and an assessment of the benefits and risks of alternative care options
and include recommendations intended to optimize patient care.
(7) 'Orthotic device' or 'orthosis' means a custom fabricated or custom fitted device that
is designed, fabricated, modified, or fitted to correct, support, or compensate for a
neuromusculoskeletal disorder or acquired condition for the purpose of stabilizing,
stretching, or immobilizing a body part, improving alignment, preventing deformities,
protecting against injury, or assisting with motion or function, and is worn on the outside
of the body to help with such structural or functional problems. Such term does not
include fabric or elastic supports, corsets, arch supports, low-temperature plastic splints,
trusses, elastic hoses, canes, crutches, soft cervical collars, dental appliances, or other
similar devices that are carried in stock and sold as over-the-counter items by a drug
store, department store, corset shop, or surgical supply facility.
(8) 'Prosthetic device' or 'prosthesis' means a custom designed, fabricated, fitted,
modified, or fitted and modified device to replace an absent external body part for
purposes of restoring physiological function or cosmesis or both. Such term does not
include artificial eyes or ears; dental appliances; cosmetic devices such as artificial
breasts, eyelashes, or wigs; or other devices that do not have a significant impact on
mobility or the musculoskeletal functions of the body.
(b) All health benefit policies renewed or issued on or after January 1, 2026, shall include
coverage for orthotic devices and prosthetic devices that are medically necessary for:
(1) Activities of daily living;
(2) Essential job related activities;
(3) Personal hygiene related activities, including, but not limited to, showering, bathing,
and toileting; or
(4) Physical activities, including, but not limited to, running, biking, swimming, and
strength training, so as to maximize the covered person's whole body health and both
upper and lower limb function.
(c) The coverage provided for in this Code section shall include no more than three
orthotic devices or prosthetic devices per affected limb per covered person during any
three-year period. Such coverage shall include:
(1) All materials and components for the use of the orthotic device or prosthetic device,
including:
(A) The orthosis or prosthesis;
(B) Structural components such as the socket;
(C) Suspension mechanisms such as the pin, lock, suction, and elevated vacuum;
(D) Hip joint, knee joint, foot, alignable parts, and terminal device;
(E) Connective components such as pads, bands, and cushions; and
(F) Consumable items such as socks, sleeves, and liners;
(2) Formulation of the device's design, fabrication, measurements and fittings;
(3) Education and training on using and maintaining such device; and
(4) The repair of such device and its components.
(d)(1) The replacement of an orthotic device or prosthetic device and its materials and
components when such device is less than three years old shall be medically necessary
if there is adequate documentation of a change in the physiological condition of the
covered person, an irreparable change in the condition of the device or any of its
components, or the condition of the device or a component of the device requires repairs
and the cost of such repairs would be more than 60 percent of the cost of the device.
(2) A socket replacement shall be medically necessary if there is adequate documentation
of a physiological need, including, but not limited to, a change in the residual limb, a
functional need change, irreparable damage, or wear and tear due to excessive weight of
a covered person or physical demands of an active covered person.
(e) A health insurer shall not be required to replace or repair an orthotic device or
prosthetic device due to misuse, malicious damage, gross neglect, loss, or theft.
(f) The coverage provided for in this Code section:
(1) Shall be considered as habilitative or rehabilitative benefits for purposes of any state
or federal requirements for coverage of essential health benefits;
(2) Shall be comparable to coverage for other medical and surgical benefits under the
health benefit policy, including restorative internal devices;
(3) May be subject to the same cost-sharing requirements that apply to other medical
devices and services covered by the health benefit policy; provided, however, that such
requirements shall not be solely applicable to such coverage; and
(4) May be limited, or the cost-sharing requirements for such coverage may be altered
for out-of-network providers; provided, however, that any limitations shall not be more
restrictive than the restrictions and requirements applicable to the out-of-network
coverage for the policy's medical or surgical coverage.
(g) Nothing in this Code section shall be construed to prohibit a health insurer from issuing
or renewing a health benefit policy which provides benefits greater than the minimum
benefits required under this Code section or from issuing or renewing a policy which
provides benefits which are generally more favorable to the covered person than those
required under this Code section.
(h) By July 1, 2032, the Commissioner shall submit a report to the House Committee on
Insurance and the Senate Insurance and Labor Committee regarding the implementation
of the coverage required under this Code section. All health insurers issuing or renewing
health benefit policies subject to the provisions of this Code section shall provide the
department with all data requested by the department for inclusion in such report,
including, but limited to, the total number of claims submitted, the total number of claims
paid, and the total amount of claims paid for the coverage provided for by this Code section
for policy years from 2026 to 2030.
(i) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section."
SECTION 2.
This Act shall become effective upon its approval by the Governor or upon its becoming law
without such approval, except that any coverage provided under a contract executed by this
state shall be subject to appropriations.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.
## Summaries written by Georgia Commons
The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.
A Georgia Senate bill would require health insurance policies to cover medically necessary orthotic and prosthetic devices, including their repair, replacement, and related training, starting January 1, 2026.
### Plain-language summary
Currently Georgia law does not specifically require health insurers to cover orthotic devices (braces and supports worn outside the body) or prosthetic devices (artificial limbs and similar replacements). This bill adds a new section to Georgia's insurance code requiring all health benefit policies issued or renewed on or after January 1, 2026 to cover these devices when medically necessary for daily living, job duties, hygiene, or physical activity.
The coverage is capped at three devices per affected limb per person every three years, but must include all materials, fitting, training, and repairs. Replacement is allowed sooner if a person's condition changes or repairs would cost more than 60 percent of a new device. Insurers can apply similar cost-sharing rules as for other medical devices but cannot single out this coverage for extra restrictions. The Insurance Commissioner must report on implementation by July 1, 2032, and can issue rules to carry out the law. The law would take effect as soon as the Governor signs it, though coverage under state contracts depends on future state funding.
### What it does
- Requires all health benefit policies issued or renewed on or after January 1, 2026 to cover medically necessary orthotic and prosthetic devices, including their materials and components.
- Limits covered devices to no more than three per affected limb per person during any three-year period, while covering fittings, training, repairs, and consumable parts like liners and socks.
- Allows earlier replacement of a device or socket if there is documented physiological change, irreparable damage, or repair costs exceeding 60 percent of a new device's cost.
- Lets insurers apply the same cost-sharing rules used for other medical devices, but bars rules that apply only to this coverage, and allows different treatment for out-of-network providers within limits.
- Requires the Insurance Commissioner to report to House and Senate insurance committees by July 1, 2032 on claims data for this coverage, and to write implementing rules.
### Who it affects
People who use orthotic braces or prosthetic limbs, health insurers offering policies regulated under Georgia's insurance code (O.C.G.A. Title 33), and the state Insurance Commissioner's office, which must collect data and issue rules to implement the new coverage requirement.
### Why it matters
Georgians who need braces, artificial limbs, or similar devices for daily activities, work, hygiene, or exercise would gain a guaranteed insurance benefit covering the device, its parts, fitting, training, and repairs, subject to a three-devices-per-limb cap every three years and standard cost-sharing.
### Key provisions
- Adds new Code Section 33-24-59.34 to Title 33 defining terms like 'orthotic device,' 'prosthetic device,' and 'medically necessary,' tied to existing definitions in O.C.G.A. ยงยง 33-24-59.32, 33-24-59.21, and 33-46-4.
- Subsection (b) requires coverage for devices needed for daily living, job-related activities, personal hygiene, and physical activities like running or swimming, for policies issued or renewed after January 1, 2026.
- Subsection (c) caps coverage at three devices per limb per person every three years and lists covered materials, components, fitting, training, and repairs.
- Subsection (d) sets conditions under which early replacement of a device or socket is considered medically necessary, including damage, physiological change, or high repair costs.
- Subsection (e) exempts insurers from covering replacement or repair caused by misuse, malicious damage, gross neglect, loss, or theft.
- Subsection (f) sets how this coverage relates to other benefit requirements, cost-sharing rules, and out-of-network limits.
- Subsection (h) requires a Commissioner's report by July 1, 2032 using insurer-submitted claims data from 2026 to 2030.
- Section 2 makes the law effective upon the Governor's signature, with coverage under state contracts subject to future appropriations (state funding).
## Status
- Status: Introduced (2025-02-26)
- Last action: Senate Read and Referred (2025-02-27)
- Sponsors: Shawn Still, Ben Watson
- Official page: https://www.legis.ga.gov/legislation/70862
> The history, votes, and amendments (95 characters) are at https://georgiacommons.org/bills/2025-2026/sb265.md?full=1