Bill Text: NY A06286 | 2019-2020 | General Assembly | Introduced


Bill Title: Requires mandatory health insurance coverage for certain individuals with prosthetic limbs; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

Spectrum: Moderate Partisan Bill (Democrat 8-2)

Status: (Introduced) 2019-03-04 - referred to insurance [A06286 Detail]

Download: New_York-2019-A06286-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          6286
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                      March 4, 2019
                                       ___________
        Introduced  by  M.  of A. CRESPO, RAIA, RIVERA, PALMESANO -- Multi-Spon-
          sored by -- M. of A. ARROYO, DAVILA, JOYNER, LAVINE, PICHARDO,  RODRI-
          GUEZ -- read once and referred to the Committee on Insurance
        AN  ACT  to  amend  the  insurance  law, in relation to mandatory health
          insurance coverage for prosthetic devices
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
     2  amended by adding a new paragraph 35 to read as follows:
     3    (35) Every policy which provides medical, major  medical,  or  similar
     4  comprehensive  type  coverage  shall  provide  coverage  for  prosthetic
     5  devices, including repairs  and  replacements,  that  are  intended  for
     6  medically necessary rehabilitative and habilitative purposes as required
     7  by  42  U.S.C.    §  18022. As such, prosthetic device coverage shall be
     8  subject to annual deductibles and coinsurance as deemed  appropriate  by
     9  the  superintendent  in  amounts  no greater than other essential health
    10  benefits covered by the policy. The term "prosthetic device" as used  in
    11  this  paragraph  includes  an artificial limb and all the components and
    12  related services that comprise prosthetic care  but  shall  not  include
    13  shoes  or  any  other  article  considered  as ordinary wearing apparel,
    14  whether or not specially constructed.  The term "policy holder" as  used
    15  in  this  paragraph shall mean a veteran of the armed forces who resides
    16  in the state of New York and whose  medical  need  for  such  prosthetic
    17  device  resulted from an injury suffered in the line of duty while serv-
    18  ing in the armed forces.
    19    § 2. Subsection (l) of section 3221 of the insurance law is amended by
    20  adding a new paragraph 21 to read as follows:
    21    (21) Every policy which provides medical, major  medical,  or  similar
    22  comprehensive  type  coverage  shall  provide  coverage  for  prosthetic
    23  devices, including repairs  and  replacements,  that  are  intended  for
    24  medically necessary rehabilitative and habilitative purposes as required
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09464-02-9

        A. 6286                             2
     1  by  42  U.S.C.    §  18022. As such, prosthetic device coverage shall be
     2  subject to annual deductibles and coinsurance as deemed  appropriate  by
     3  the  superintendent  in  amounts  no greater than other essential health
     4  benefits  covered by the policy. The term "prosthetic device" as used in
     5  this paragraph includes an artificial limb and all  the  components  and
     6  related  services  that  comprise  prosthetic care but shall not include
     7  shoes or any other  article  considered  as  ordinary  wearing  apparel,
     8  whether  or not specially constructed.  The term "policy holder" as used
     9  in this paragraph shall mean a veteran of the armed forces  who  resides
    10  in  the  state  of  New  York and whose medical need for such prosthetic
    11  device resulted from an injury suffered in the line of duty while  serv-
    12  ing in the armed forces.
    13    §  3.  Section  4303  of  the insurance law is amended by adding a new
    14  subsection (ss) to read as follows:
    15    (ss) Every policy which provides medical, major  medical,  or  similar
    16  comprehensive  type  coverage  shall  provide  coverage  for  prosthetic
    17  devices, including repairs  and  replacements,  that  are  intended  for
    18  medically necessary rehabilitative and habilitative purposes as required
    19  by  42  U.S.C.  §  18022.  As  such, prosthetic device coverage shall be
    20  subject to annual deductibles and coinsurance as deemed  appropriate  by
    21  the  superintendent  in  amounts  no greater than other essential health
    22  benefits covered by the policy. The term "prosthetic device" as used  in
    23  this  subsection  includes  an artificial limb and all of the components
    24  and related services that comprise prosthetic care but shall not include
    25  shoes or any other  article  considered  as  ordinary  wearing  apparel,
    26  whether  or not specially constructed.  The term "policy holder" as used
    27  in this subsection shall mean a veteran of the armed forces who  resides
    28  in  the  state  of  New  York and whose medical need for such prosthetic
    29  device resulted from an injury suffered in the line of duty while  serv-
    30  ing in the armed forces.
    31    §  4.  This  act shall take effect on the ninetieth day after it shall
    32  have become a law and shall apply  to  policies  and  contracts  issued,
    33  renewed, altered, or amended on or after such effective date.
feedback