senate Bill S907

Relates to insurance coverage for certain prostheses

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Sponsor

Bill Status


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

  • 09 / Jan / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE

Summary

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.

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Bill Details

See Assembly Version of this Bill:
A1607
Versions:
S907
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: S2864, A3545
2009-2010: S3027, A4051
2007-2008: A4651

Sponsor 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.

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

                                   907

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (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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