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Source:
Colorado Statutes/TITLE 10 INSURANCE/HEALTH CARE COVERAGE/ARTICLE 16 HEALTH CARE COVERAGE/PART 1 SHORT TITLE - DEFINITIONS - GENERAL PROVISIONS/10-16-104. Mandatory coverage provisions.

(14) Prosthetic devices. (a) Any health benefit plan, except supplemental policies covering aspecified disease or other limited benefit, that provides hospital, surgical, or medical expenseinsurance shall provide coverage for benefits for prosthetic devices that equal those benefitsprovided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. secs. 1395k, 1395l, and 1395m and 42 CFR 414.202, 414.210, 414.228, and 410.100, asapplicable to this subsection (14).

(b) For the purposes of this subsection (14) "prosthetic device" means an artificial device toreplace, in whole or in part, an arm or leg.

(c) A health benefit plan may require prior authorization for prosthetic devices in the samemanner that prior authorization is required for any other covered benefit.

(d) Covered benefits are limited to the most appropriate model that adequately meets the medicalneeds of the patient as determined by the insured's treating physician.

(e) Repairs and replacements of prosthetic devices are also covered, subject to copayments anddeductibles, unless necessitated by misuse or loss.

(f) A carrier may require that, if coverage is provided through a managed care plan, the benefitsmandated pursuant to this subsection (14) shall be covered benefits only if the prosthetic devicesare provided by a vendor and prosthetic services are rendered by a provider who contracts with oris designated by the carrier, to the extent that a carrier provides in-network and out-of-networkservices, the coverage for the prosthetic device shall be offered no less extensively.

(15) Notwithstanding any provision to the contrary, a small employer may purchase healthbenefit coverage that does not include the coverage for benefits pursuant to subsections (4), (5),(8), (9), (10), and (12) of this section through a basic health benefit plan pursuant to section 10-16-105 (7.2) (b) (I).

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