This bill has been amended

Bill S3951-2013

Relates to mandatory health insurance coverage for providing prosthetic devices

Relates to mandatory health insurance coverage for providing prosthetic devices equal to or above Medicare's standard of coverage; includes the repair or replacement of a prosthetic device required to be worn or used by a policy holder; includes expenses for assessment, evaluation, treatment, management, and follow-up care.

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  • Jan 8, 2014: REFERRED TO INSURANCE
  • Feb 28, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S3951

TITLE OF BILL: An act to amend the insurance law, in relation to mandatory health insurance coverage for providing prosthetic devices

PURPOSE OR GENERAL IDEA OF BILL: To provide mandatory coverage for prosthetic devices for children who periodically need to have these devices altered or replaced due to normal physical growth, for adults whose conditions change and to account for updated technology, repair and replacement.

SUMMARY OF SPECIFIC PROVISIONS:

Sections 1. 2 & 3: Amends subsection (i) of section 3216, subsection (1) of section 3221, and section 4303 of the Insurance Law to require that every policy which provides medical, major medical, or similar comprehensive type coverage shall include coverage equal to or above Medicare's standard of coverage for prosthetic devices.

Section 4: Effective date.

JUSTIFICATION: Though not as common as in adults, children, even infants may need a prosthetic device due to the loss of a limb. The overwhelming experience for a child of losing a limb does not need to be compounded by a long battle to pay for treatment. This legislation will provide coverage to children and adults for prosthetic devices and to replace or change these devices as needed to account for natural growth and repairs of such devices.

LEGISLATIVE HISTORY: S.2893 of 2010: Died in Senate Insurance Committee, Died in Assembly Insurance Committee S.2893 of 2009: Died in Senate Insurance Committee, Died in Assembly Insurance Committee S.1672 of 2008: Died in Senate Insurance Committee, Died in Assembly Insurance Committee S.1672 of 2007: Died in Senate Insurance Committee, Died in Assembly Insurance Committee S.599 of 2006: Died in Senate Insurance Committee, Died in Assembly Insurance Committee S.599 of 2005: Died in Senate Insurance Committee, Died in Assembly Insurance Committee

FISCAL IMPLICATIONS: None to the state.

EFFECTIVE DATE: This act shall take effect on the ninetieth day after it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.


Text

STATE OF NEW YORK ________________________________________________________________________ 3951 2013-2014 Regular Sessions IN SENATE February 28, 2013 ___________
Introduced by Sen. BONACIC -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to mandatory health insurance coverage for providing prosthetic devices THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 30 to read as follows: (30) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU- ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. S 2. Subsection (l) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU- ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. S 3. Section 4303 of the insurance law is amended by adding a new subsection (jj) to read as follows: (JJ) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU- ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED. S 4. This act shall take effect on the ninetieth day after it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.

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