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; coverage includes expenses for assessment, evaluation, treatment, management, and follow-up care.

---

S3951-2013 Actions

• Feb 28, 2013: REFERRED TO INSURANCE

S3951-2013 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.

S3951-2013 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

                                    3951

                         2013-2014 Regular Sessions

                              I N  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

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD02404-01-3

 S. 3951                             2

  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.