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 - Dead) 2020-07-06 - enacting clause stricken [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. LBD09464-02-9A. 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.