S T A T E O F N E W Y O R K
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4051
2009-2010 Regular Sessions
I N A S S E M B L Y
January 29, 2009
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Introduced by M. of A. CYMBROWITZ -- read once and referred 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 26 to read as follows:
(26) (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 PROSTHESES FOR THE LIFE OF THE POLICY.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:
(15) (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.
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A. 4051 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 PROSTHESES PER COVERED PERSON FOR THE LIFETIME
OF THE POLICY.
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (ff) to read as follows:
(FF)(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 PROSTHESES 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.