S907-2013 Actions

• Jan 9, 2013: REFERRED TO INSURANCE

S907-2013 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.

S907-2013 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                          907
 2013-2014 Regular Sessions
 I N  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
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD03793-01-3
 
       S. 907                              2
 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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