senate Bill S3951A

Relates to mandatory health insurance coverage for providing prosthetic devices

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 28 / Feb / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 29 / Jan / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 29 / Jan / 2014
    • PRINT NUMBER 3951A

Summary

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

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Bill Details

See Assembly Version of this Bill:
A1103A
Versions:
S3951
S3951A
Legislative Cycle:
2013-2014
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221 & 4303, Ins L
Versions Introduced in Previous Legislative Cycles:
2011-2012: A497, A497
2009-2010: A770, A770
2007-2008: A1274, A1274

Sponsor Memo

BILL NUMBER:S3951A

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.

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

                                 3951--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            February 28, 2013
                               ___________

Introduced  by  Sens. BONACIC, ROBACH -- read twice and ordered printed,
  and when printed to be committed to  the  Committee  on  Insurance  --
  recommitted  to  the  Committee on Insurance in accordance with Senate
  Rule  6,  sec.  8  --  committee  discharged,  bill  amended,  ordered
  reprinted as amended and recommitted to said committee

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02404-02-4

S. 3951--A                          2

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  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (oo) to read as follows:
  (OO) 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.

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