Kentucky SB97 - Health Benefit Plans Prostheses and Orthoses Coverage Mandate
Summary
Kentucky Governor signed SB97 into law, requiring health benefit plans to provide coverage for prostheses and orthoses. The Act establishes minimum coverage requirements, utilization review standards, network adequacy requirements for providers, and reporting obligations for insurers. Self-insured state employee health plans and state postsecondary institution plans must also comply. The law applies to plans issued or renewed on or after January 1, 2027.
What changed
Kentucky enacted SB97 creating a new section of Subtitle 17A of KRS Chapter 304 requiring health benefit plans to provide coverage for prostheses and orthoses. The Act establishes minimum coverage requirements, mandates nondiscriminatory utilization review decisions, requires notice of insured rights and denial procedures, and creates network adequacy standards for providers. Amends KRS 164.2871 and 18A.225 to extend requirements to self-insured state postsecondary institution health plans and the state employee health plan. Insurers must submit compliance reports to the Kentucky Department of Insurance.
Health insurers and self-insured plans must revise coverage policies, update utilization review procedures, develop adequate provider networks, and prepare compliance reports by the January 1, 2027 effective date. Legal and compliance teams should review the statutory amendments to KRS 164.2871 and 18A.225 affecting state employee and postsecondary institution health plans.
What to do next
- Update health benefit plan coverage policies to include prostheses and orthoses
- Establish network adequacy for prosthesis and orthosis providers
- Prepare compliance reports for Kentucky Department of Insurance
Archived snapshot
Apr 8, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
ChangeBridge / Kentucky / SB97 Signed by Governor SB97 Senate Bill Signed by Governor 2026-04-07
AN ACT relating to coverage for prostheses and orthoses.
Create a new section of Subtitle 17A of KRS Chapter 304 to require health benefit plans to provide coverage for prostheses and orthoses; establish minimum requirements for the required coverage; require utilizations review decisions to be made in a nondiscriminatory manner; require an insurer or its private review agent to provide notice of certain rights of the insured; establish notice requirements for denials; establish network adequacy requirements for the provision of a prosthesis or orthosis that is required to be covered; establish reporting requirements for insurers and the commissioner of the Department of Insurance relating to the required coverage; amend KRS 164.2871 and 18A.225 to require self-insured group health plans offering by the governing board of state postsecondary education institutions and the state employee health plan to comply with the requirements relating to coverage for prostheses and orthoses; provide that the Act applies to health benefit plans issued or renewed on or after January 1, 2027; EFFECTIVE January 1, 2027.
Bill Details
State Kentucky
Session 2026 Regular Session
Chamber Senate
Official Source apps.legislature.ky.gov/record/26RS/sb97.html
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Sponsors
Rick Girdler (Sen - R) Julie Raque Adams (Sen - R) Matthew Deneen (Sen - R) Greg Elkins (Sen - R) Scott Madon (Sen - R) Amanda Mays Bledsoe (Sen - R) Matt Nunn (Sen - R) Steve Rawlings (Sen - R) Aaron Reed (Sen - R) Brandon Storm (Sen - R) Phillip Wheeler (Sen - R)
Action History
2026-04-07 S signed by Governor 2026-03-31 S delivered to Governor 2026-03-31 S enrolled, signed by Speaker of the House 2026-03-31 S enrolled, signed by President of the Senate 2026-03-31 S passed 38-0 2026-03-31 S Senate concurred in Committee Substitute (1) and Floor Amendment (1) 2026-03-31 S posted for passage for concurrence in House Floor Amendment (1) and Committee Substitute (1) 2026-03-27 S to Rules (S) 2026-03-27 S received in Senate 2026-03-27 H 3rd reading, passed 95-0 with Committee Substitute (1) and Floor Amendment (1) 2026-03-27 H floor amendment (1) adopted 2026-03-27 H Committee Substitute (1) adopted 2026-03-26 H floor amendment (1) filed to Committee Substitute 2026-03-26 H posted for passage in the Regular Orders of the Day for Friday, March 27 2026 2026-03-26 H 2nd reading, to Rules 2026-03-25 H reported favorably, 1st reading, to Calendar with Committee Substitute (1) 2026-03-24 H to Banking & Insurance (H) 2026-03-13 H to Committee on Committees (H) 2026-03-13 H received in House 2026-03-12 S 3rd reading, passed 38-0 with Committee Substitute (1) 2026-03-11 S posted for passage in the Regular Orders of the Day for Thursday, March 12 2026 2026-03-11 S 2nd reading, to Rules 2026-03-10 S reported favorably, 1st reading, to Calendar with Committee Substitute (1) 2026-03-06 S to Banking & Insurance (S) 2026-01-15 S to Committee on Committees (S) 2026-01-15 S introduced in Senate
Votes
2026-03-12 Senate: Third Reading RSN# 3918 Yea: 38 Nay: 0 2026-03-27 House: Veto Override RCS# 343 Yea: 95 Nay: 0 2026-03-31 Senate: Third Reading RSN# 4079 Yea: 38 Nay: 0
Committee Referrals
2026-01-15 S Committee on Committees 2026-03-06 S Banking and Insurance 2026-03-11 S Rules 2026-03-13 H Committee On Committees 2026-03-24 H Banking and Insurance 2026-03-26 H Rules 2026-03-27 S Rules
Amendments
0000-00-00 Senate Committee Substitute 0000-00-00 Senate Committee Substitute 0000-00-00 Senate Committee Substitute 0000-00-00 Senate Committee Substitute 0000-00-00 Senate Committee Substitute 0000-00-00 House Committee Substitute 0000-00-00 House Committee Substitute 0000-00-00 House Committee Substitute 0000-00-00 House Committee Substitute 0000-00-00 House Committee Substitute 0000-00-00 House Floor Amendment
Bill Text Versions
0000-00-00 Introduced 0000-00-00 Engrossed 0000-00-00 Enrolled
Subjects
Health Benefit Plan Mandate Local Mandate State Employee Health Plan Mandate Disabilities Education, Higher Effective Dates, Delayed Health and Medical Services Health Care Professionals Insurance, Health Reports Mandated State Employees Actuarial Analysis Legislative data powered by LegiScan (CC BY 4.0)
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