S T A T E O F N E W Y O R K
________________________________________________________________________
2173
2013-2014 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2013
___________
Introduced by M. of A. CYMBROWITZ, GALEF, COLTON -- Multi-Sponsored by
-- M. of A. HOOPER -- read once and referred to the Committee on
Insurance
AN ACT to amend the insurance law, in relation to requiring individual
and group or blanket accident or health insurance policies and hospi-
tal service corporations, health service corporations, and medical
indemnity corporations, which provide hospital, surgical or medical
coverage to include coverage for the purchase of cranial prostheses
when prescribed as medically necessary
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 CRANIAL PROSTHESES WORN FOR PERMANENT OR TEMPORARY HAIR LOSS SUFFERED
AS A RESULT OF 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 EDUCATION LAW ISSUES A WRITTEN ORDER FOR SUCH PURCHASE TO SIGNIFY
HIS OR HER OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE
THE PATIENT'S PHYSICAL OR PSYCHOLOGICAL 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
COVERAGE MAY BE LIMITED TO ONE CRANIAL PROSTHESIS PER COVERED PERSON FOR
THE LIFETIME 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:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05986-01-3
A. 2173 2
(19) (A) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MAJOR MEDICAL OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE
PURCHASE OF CRANIAL PROSTHESES WORN FOR PERMANENT OR TEMPORARY HAIR LOSS
SUFFERED AS A RESULT OF 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 EDUCATION LAW ISSUES A WRITTEN ORDER FOR SUCH PURCHASE TO SIGNIFY
HIS OR HER OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE
THE PATIENT'S PHYSICAL OR PSYCHOLOGICAL 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
COVERAGE MAY BE LIMITED TO ONE CRANIAL 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
CRANIAL PROSTHESES WORN FOR PERMANENT OR TEMPORARY HAIR LOSS SUFFERED AS
A RESULT OF ACCIDENT, INJURY OR DISEASE, OR THE TREATMENT OF SUCH CONDI-
TIONS, 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 PURCHASE TO SIGNIFY HIS OR
HER OPINION THAT SUCH PURCHASE IS MEDICALLY NECESSARY TO PROMOTE THE
PATIENT'S PHYSICAL OR PSYCHOLOGICAL 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
COVERAGE MAY BE LIMITED TO ONE CRANIAL PROSTHESIS PER COVERED PERSON FOR
THE LIFETIME OF THE POLICY.
S 4. This act shall take effect on the ninetieth day after it shall
have become a law and shall apply according to its terms to all poli-
cies, contracts and certificates issued, renewed, modified, altered or
amended on or after such date.