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Assembly Bill A6820C

2013-2014 Legislative Session

Requires mandatory health insurance coverage for prosthetic devices

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Archive: Last Bill Status - In Senate Committee Rules Committee

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Bill Amendments

co-Sponsors

multi-Sponsors

2013-A6820 - Details

See Senate Version of this Bill:
S5390
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A7549, A7545, S2574, S5350
2017-2018: A6304, S2875
2019-2020: A6286, S4259
2021-2022: S4801
2023-2024: S6039
2025-2026: S4215

2013-A6820 - Summary

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.

2013-A6820 - Bill Text download pdf 

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

                                  6820

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 19, 2013
                               ___________

Introduced by M. of A. CRESPO -- 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:

  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 FOR POLICY  HOLD-
ERS.  THIS  SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROS-
THETIC 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,
EVALUATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP  CARE.  COVERAGE  SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE  IS  THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL
NEEDS OF THE POLICY HOLDER TO PERFORM  ACTIVITIES  OF  DAILY  LIVING  OR
ESSENTIAL  JOB-RELATED ACTIVITIES.  THE TERM "PROSTHETIC DEVICE" AS USED
IN THIS PARAGRAPH INCLUDES AN ARTIFICIAL  LIMB  BUT  SHALL  NOT  INCLUDE
SHOES  OR  ANY  OTHER  ARTICLE  CONSIDERED  AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.  THE TERM "POLICY HOLDER" AS  USED
IN  THIS  PARAGRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES
IN THE STATE OF NEW YORK.
  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 FOR POLICY  HOLD-
ERS.  THIS  SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROS-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-02-3

co-Sponsors

multi-Sponsors

2013-A6820A - Details

See Senate Version of this Bill:
S5390
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A7549, A7545, S2574, S5350
2017-2018: A6304, S2875
2019-2020: A6286, S4259
2021-2022: S4801
2023-2024: S6039
2025-2026: S4215

2013-A6820A - Summary

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.

2013-A6820A - Bill Text download pdf 

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

                                 6820--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 19, 2013
                               ___________

Introduced  by  M.  of  A.  CRESPO,  MILLER,  GUNTHER,  SCHIMEL, MOSLEY,
  BARRETT, COLTON, COOK, MAGNARELLI, TITONE, DIPIETRO, FINCH, MONTESANO,
  GRAF, DUPREY, RIVERA, HOOPER -- Multi-Sponsored by -- M. of A. ARROYO,
  BRENNAN, KEARNS, McLAUGHLIN, PALMESANO, PERRY, ROBINSON, STEC, THIELE,
  WEISENBERG -- read once and referred to the Committee on Insurance  --
  recommitted  to the Committee on Judiciary in accordance with Assembly
  Rule  3,  sec.  2  --  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 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 FOR POLICY  HOLD-
ERS.  THIS  SHALL INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROS-
THETIC 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,
EVALUATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP  CARE.  COVERAGE  SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE  IS  THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL
NEEDS OF THE POLICY HOLDER TO PERFORM  ACTIVITIES  OF  DAILY  LIVING  OR
ESSENTIAL  JOB-RELATED ACTIVITIES.  THE TERM "PROSTHETIC DEVICE" AS USED
IN THIS PARAGRAPH INCLUDES AN ARTIFICIAL  LIMB  BUT  SHALL  NOT  INCLUDE
SHOES  OR  ANY  OTHER  ARTICLE  CONSIDERED  AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.  THE TERM "POLICY HOLDER" AS  USED
IN  THIS  PARAGRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES
IN THE STATE OF NEW YORK.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-04-4

co-Sponsors

multi-Sponsors

2013-A6820B - Details

See Senate Version of this Bill:
S5390
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A7549, A7545, S2574, S5350
2017-2018: A6304, S2875
2019-2020: A6286, S4259
2021-2022: S4801
2023-2024: S6039
2025-2026: S4215

2013-A6820B - Summary

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.

2013-A6820B - Bill Text download pdf 

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

                                 6820--B

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 19, 2013
                               ___________

Introduced  by  M.  of  A.  CRESPO,  MILLER,  GUNTHER,  SCHIMEL, MOSLEY,
  BARRETT, COLTON, COOK, MAGNARELLI, TITONE, DiPIETRO, FINCH, MONTESANO,
  GRAF, DUPREY, RIVERA, HOOPER, CAHILL, ROBINSON, JAFFEE, OTIS, SCARBOR-
  OUGH, SALADINO, CERETTO, RA, LALOR, BENEDETTO,  JOHNS  --  Multi-Spon-
  sored by -- M. of A.  ARROYO, BRENNAN, GIGLIO, HIKIND, JACOBS, KEARNS,
  MARKEY,  McLAUGHLIN,  PALMESANO, PEOPLES-STOKES, PERRY, STEC, SWEENEY,
  THIELE, WEISENBERG -- read once  and  referred  to  the  Committee  on
  Insurance  --  recommitted to the Committee on Insurance in accordance
  with Assembly Rule 3, sec. 2 -- committee  discharged,  bill  amended,
  ordered  reprinted  as  amended  and  recommitted to said committee --
  again reported from said committee with amendments, ordered  reprinted
  as amended and recommitted to said committee

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:

  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  AND PROVIDES COVERAGE FOR DURABLE MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED   FOR   MEDICALLY  NECESSARY  REHABILITATIVE  AND  HABILITATIVE
PURPOSES AS REQUIRED BY 42 U.S.C. S 18022  THAT  IS  EQUIVALENT  TO  THE
COVERAGE  PROVIDED  FOR  DURABLE MEDICAL EQUIPMENT.   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,  EVALUATION,  TREATMENT,
MANAGEMENT,  AND  FOLLOW-UP  CARE.  COVERAGE  SHALL NOT BE DENIED IF THE
POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE IS  THE  MOST
APPROPRIATE  MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF THE POLICY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-06-4

co-Sponsors

multi-Sponsors

2013-A6820C (ACTIVE) - Details

See Senate Version of this Bill:
S5390
Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2015-2016: A7549, A7545, S2574, S5350
2017-2018: A6304, S2875
2019-2020: A6286, S4259
2021-2022: S4801
2023-2024: S6039
2025-2026: S4215

2013-A6820C (ACTIVE) - Summary

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.

2013-A6820C (ACTIVE) - Bill Text download pdf 

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

                                 6820--C

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                             April 19, 2013
                               ___________

Introduced  by  M.  of  A.  CRESPO,  MILLER,  GUNTHER,  SCHIMEL, MOSLEY,
  BARRETT, COLTON, COOK, MAGNARELLI, TITONE, DiPIETRO, FINCH, MONTESANO,
  GRAF, DUPREY, RIVERA, HOOPER, CAHILL, ROBINSON, JAFFEE, OTIS, SCARBOR-
  OUGH, SALADINO, CERETTO, RA, LALOR, BENEDETTO,  JOHNS  --  Multi-Spon-
  sored by -- M. of A.  ARROYO, BRENNAN, GIGLIO, HIKIND, JACOBS, KEARNS,
  MARKEY,  McLAUGHLIN,  PALMESANO, PEOPLES-STOKES, PERRY, STEC, SWEENEY,
  THIELE, WEISENBERG -- read once  and  referred  to  the  Committee  on
  Insurance  --  recommitted to the Committee on Insurance in accordance
  with Assembly Rule 3, sec. 2 -- committee  discharged,  bill  amended,
  ordered  reprinted  as  amended  and  recommitted to said committee --
  again reported from said committee with amendments, ordered  reprinted
  as  amended and recommitted to said committee -- reported and referred
  to the Committee on Ways  and  Means  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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:

  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 AND PROVIDES COVERAGE  FOR  DURABLE  MEDICAL
EQUIPMENT  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC  DEVICES  THAT  ARE
INTENDED  FOR  MEDICALLY  NECESSARY  REHABILITATIVE   AND   HABILITATIVE
PURPOSES  AS  REQUIRED  BY  42  U.S.C. S 18022 THAT IS EQUIVALENT TO THE
COVERAGE PROVIDED FOR DURABLE MEDICAL EQUIPMENT.  COVERAGE SHALL NOT  BE
DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC DEVICE
IS THE MOST APPROPRIATE MODEL THAT ADEQUATELY MEETS THE MEDICAL NEEDS OF
THE  POLICY  HOLDER.  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA-
GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR  ANY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-08-4

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