Bill S907-2013

Relates to insurance coverage for certain prostheses

Relates to insurance coverage for prostheses which are necessary to compensate for the loss of a limb due to accident, injury or disease or the treatment of such conditions provided a treating physician issues a written order for such purchase stating that such purchase is medically necessary to promote the patient's well-being or to promote the healing process.

Details

Actions

  • Jan 8, 2014: REFERRED TO INSURANCE
  • Jan 9, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S907

TITLE OF BILL: An act to amend the insurance law, in relation to insurance coverage for prostheses

SUMMARY OF PROVISIONS: This bill amends various sections of the insurance law to require that health insurers provide coverage for medically necessary prostheses upon the prescription of a licensed medical provider.

JUSTIFICATION: The purpose of this bill is to ensure that medical insurance will provide coverage for the cost of a medically necessary prosthetic device. Many insurers deny coverage for prosthetics even though they are medically necessary in order to ensure proper bodily function. This legislation will address this issue and help ensure that individuals can have access to necessary prosthetics at reasonable prices.

LEGISLATIVE HISTORY: 2011-12 S.2864; 2009-10, S.3027; 2007-08, S.3788; 2001-02, S.6116

FISCAL IMPLICATIONS: None to state.

EFFECTIVE DATE: This act shall take effect on the one hundred eightieth day after it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 907 2013-2014 Regular Sessions IN SENATE (PREFILED) January 9, 2013 ___________
Introduced by Sen. LAVALLE -- 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 insurance coverage for prostheses 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) (A) EVERY INDIVIDUAL POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMI- LAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE PURCHASE OF PROSTHESES WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF A LIMB DUE TO ACCIDENT, INJURY OR DISEASE OR THE TREATMENT OF SUCH CONDITIONS, PROVIDED THAT THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCA- TION LAW ISSUES A WRITTEN ORDER FOR SUCH PURCHASE STATING HIS OR HER OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE THE PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS. (B) SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND COIN- SURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSIST- ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER- AGE MAY BE LIMITED TO ONE PROSTHESIS FOR THE LIFE OF THE POLICY. S 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) (A) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE PURCHASE OF PROSTHESES WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF A LIMB DUE TO ACCIDENT, INJURY OR DISEASE, OR THE TREATMENT OF SUCH CONDITION, PROVIDED THAT THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW ISSUES A WRITTEN ORDER FOR SUCH PURPOSE STATING HIS OR HER
OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE THE PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS. (B) SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND COIN- SURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSIST- ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER- AGE MAY BE LIMITED TO ONE PROSTHESIS PER COVERED PERSON FOR THE LIFETIME OF THE POLICY. S 3. Section 4303 of the insurance law is amended by adding a new subsection (jj) to read as follows: (JJ)(1) EVERY CONTRACT ISSUED BY A CORPORATION SUBJECT TO THE PROVISIONS OF THIS ARTICLE WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE, SHALL INCLUDE COVERAGE FOR THE PURCHASE OF PROSTHESES WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF A LIMB AS A RESULT OF ACCIDENT, INJURY OR DISEASE, OR THE TREATMENT OF SUCH CONDI- TION, PROVIDED THAT THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCA- TION LAW, ISSUES A WRITTEN ORDER FOR SUCH PURCHASE STATING HIS OR HER OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE THE PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS. (2) SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND COIN- SURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSIST- ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER- AGE MAY BE LIMITED TO ONE PROSTHESIS PER COVERED PERSON FOR THE LIFETIME OF THE POLICY. S 4. This act shall take effect on the one hundred eightieth day after it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such date.

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