senate Bill S5390C

2013-2014 Legislative Session

Requires mandatory health insurance coverage for prosthetic devices

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Sponsored By

Archive: Last Bill Status - In Committee


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 11, 2014 print number 5390c
amend and recommit to insurance
Jun 09, 2014 print number 5390b
amend and recommit to insurance
Jan 29, 2014 print number 5390a
amend and recommit to insurance
Jan 08, 2014 referred to insurance
May 16, 2013 referred to insurance

Bill Amendments

Original
A
B
C (Active)
Original
A
B
C (Active)

S5390 - Bill Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390 - Bill Texts

view 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.

view sponsor memo
BILL NUMBER:S5390

TITLE OF BILL: An act to amend the insurance law, in relation to
mandatory health insurance coverage for prosthetic devices

PURPOSE OR GENERAL IDEA OF THE BILL: To ensure that state-of-the-art
prosthetics are available to amputees, without restrictions, including
military veterans injured during service.

SUMMARY OF SPECIFIC PROVISIONS:

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,
evaluation, treatment, management, and follow-up care.

Section 2. Subsection (1) 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
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.

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

(jj) 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,
evaluation, treatment, management, and follow-up care.

JUSTIFICATION: Two recent wars involving the United States, Iraq and
Afghanistan has left over 600 military men and women as amputees with
life-long injuries. Each year 185,000 amputations occur in the US and
there are nearly 2 million people living with limb loss in the US.
Improving access to quality and updated prosthetic devices will
improve the quality of life of veterans and other amputees, while
he-Thing-to reduce other medical costs related to lack of mobility and
associated physical and emotional health.


According to the Veterans Health Administration, approximately 6
percent of wounded service members returning from Iraq are individuals
with amputations. As a society, we owe these veterans the best of our
efforts to help them live improved lives after their sacrifice for our
nation.

The most important advantage of having prosthetic legs is the freedom
of movement that a lack of legs prohibits. Prosthetic legs are
attached to a partially severed leg and are custom built to the
specifications of the users body. The prosthetic equipment, mimic the
movement of natural legs and allow for full movement. These
prosthetics may be more difficult to use than natural legs, and
certain terrains will be hard to impossible to navigate, but with the
alternative of being confined to a wheelchair, the prosthetics raise
the quality of life of the user by lifting the limitations inherent to
a wheelchair.

On the emotional and psychological side of this issue, having
prosthetics not only gives the amputee the will power to continue to
be a productive member of society, it also enables them to somewhat
continue their life as they had it before. While it's an unfortunate
experience to go through, we have the power to make amputee's feel
alive again.

For other Americans, improving their quality of life after an
amputation can help lead them to more active and fulfilling lives,.
African Americans are up to four times more likely to have an
amputation than white Americans because of gaps and inequalities in
the delivery of health care, as well as environment factors that lead
to other diseases which lead to amputations.

This legislation ensures that our veterans are provided with the best
prosthetic devices available and extends the same benefit to all other
amputees alter two years of enactment of this act.

PRIOR LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT: None

EFFECTIVE DATE: This act shall take effect May 1, 2014 and section 4-6
shall take effect on April 1, 2016.

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

                                  5390

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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  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

S. 5390                             2

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  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 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 SUBSECTION 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 SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES
IN THE STATE OF NEW YORK.
  S 4. Paragraph 30 of subsection (i) of section 3216 of  the  insurance
law, as added by section one of this act, is amended 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  5.  Paragraph 19 of subsection (l) of section 3221 of the insurance
law, as added by section two of this act, is amended 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-

S. 5390                             3

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 6. Subsection (oo) of section 4303 of the insurance law, as added by
section three of this act, is amended 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 [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  subsection  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 7. This act shall  take  effect  May  1,  2014;  provided,  however,
sections  four,  five  and six of this act shall take effect on April 1,
2016.

S5390A - Bill Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390A - Bill Texts

view 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.

view sponsor memo
BILL NUMBER:S5390A

TITLE OF BILL: An act to amend the insurance law, in relation to
mandatory health insurance coverage for prosthetic devices

PURPOSE OR GENERAL IDEA OF THE BILL: To ensure that state-of-the-art
prosthetics are available to amputees, without restrictions, including
military veterans injured during service.

SUMMARY OF SPECIFIC PROVISIONS:

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,
evaluation, treatment, management, and follow-up care.

Section 2. Subsection (1) 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
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.

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

(jj) 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,
evaluation, treatment, management, and follow-up care.

JUSTIFICATION: Two recent wars involving the United States, Iraq and
Afghanistan has left over 600 military men and women as amputees with
life-long injuries. Each year 185,000 amputations occur in the US and
there are nearly 2 million people living with limb loss in the US.
Improving access to quality and updated prosthetic devices will
improve the quality of life of veterans and other amputees, while the
thing to reduce other medical costs related to lack of mobility and
associated physical and emotional health.


According to the Veterans Health Administration, approximately 6
percent of wounded service members returning from Iraq are individuals
with amputations. As a society, we owe these veterans the best of our
efforts to help them live improved lives after their sacrifice for cur
nation.

The most important advantage of having prosthetic legs is the freedom
of movement that a lack of legs prohibits. Prosthetic legs are
attached to a partially severed leg and are custom built to the
specifications of the users body. The prosthetic equipment, mimic the
movement of natural legs and allow for full movement. These
prosthetics may be more difficult to use than natural legs, and
certain terrains will be hard to impossible to navigate, but with the
alternative of being confined to a wheelchair, the prosthetics raise
the quality of life of the user by lifting the limitations inherent to
a wheelchair.

On the emotional and psychological side of this issue, having
prosthetics nor only gives the amputee the will power to continue to
be a productive member of society, it also enables them to somewhat
continue their life as they had it before. While it's an unfortunate
experience to go through, we have the power to make amputee's feel
alive again.

For other Americans, improving their quality of life after an
amputation can help lead them to more active and fulfilling lives.
African Americans are up to four times more likely to have an
amputation than white Americans because of gaps and inequalities in
the delivery of health care, as well as environment factors that lead
to other diseases which lead to amputations.

This legislation ensures that our veterans are provided with the best
prosthetic devices available and extends the same benefit to all other
amputees alter two years of enactment of this act.

PRIOR LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT: None

EFFECTIVE DATE: This act shall take effect May 1, 2015 and section 4-6
shall take effect on April 1, 2017.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5390--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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 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:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-03-4

S. 5390--A                          2

  (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-
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  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 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 SUBSECTION 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 SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES
IN THE STATE OF NEW YORK.
  S 4. Paragraph 30 of subsection (i) of section 3216 of  the  insurance
law, as added by section one of this act, is amended 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. 5390--A                          3

  S  5.  Paragraph 19 of subsection (l) of section 3221 of the insurance
law, as added by section two of this act, is amended 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-
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 6. Subsection (oo) of section 4303 of the insurance law, as added by
section three of this act, is amended 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 [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 subsection 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  7.  This  act  shall  take  effect  May 1, 2015; provided, however,
sections four, five and six of this act shall take effect April 1, 2017.

S5390B - Bill Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390B - Bill Texts

view 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.

view sponsor memo
BILL NUMBER:S5390B

TITLE OF BILL: An act to amend the insurance law, in relation to manda-
tory health insurance coverage for prosthetic devices

PURPOSE OR GENERAL IDEA OF THE BILL: To ensure that state-of-the-art
prosthetics are available to amputees, without restrictions, including
military veterans injured during service.

SUMMARY OF SPECIFIC PROVISIONS:

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.

Section 2. Subsection (1) 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
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.

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

(jj) 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.

JUSTIFICATION: Two recent wars involving the United States, Iraq and
Afghanistan has left over 600 military men and women as amputees with
life-long injuries. Each year 185,000 amputations occur in the US and
there are nearly 2 million people living with limb loss in the US.
Improving access to quality and updated prosthetic devices will improve

the quality of life of veterans and other amputees, while the thing to
reduce other medical costs related to lack of mobility and associated
physical and emotional health.

According to the Veterans Health Administration, approximately 6 percent
of wounded service members returning from Iraq are individuals with
amputations. As a society, we owe these veterans the best of our efforts
to help them live improved lives after their sacrifice for cur nation.

The most important advantage of having prosthetic legs is the freedom of
movement that a lack of legs prohibits. Prosthetic legs are attached to
a partially severed leg and are custom built to the specifications of
the users body. The prosthetic equipment, mimic the movement of natural
legs and allow for full movement. These prosthetics may be more diffi-
cult to use than natural legs, and certain terrains will be hard to
impossible to navigate, but with the alternative of being confined to a
wheelchair, the prosthetics raise the quality of life of the user by
lifting the limitations inherent to a wheelchair.

On the emotional and psychological side of this issue, having prosthet-
ics nor only gives the amputee the will power to continue to be a
productive member of society, it also enables them to somewhat continue
their life as they had it before. While it's an unfortunate experience
to go through, we have the power to make amputee's feel alive again.

For other Americans, improving their quality of life after an amputation
can help lead them to more active and fulfilling lives. African Ameri-
cans are up to four times more likely to have an amputation than white
Americans because of gaps and inequalities in the delivery of health
care, as well as environment factors that lead to other diseases which
lead to amputations.

This legislation ensures that our veterans are provided with the best
prosthetic devices available and extends the same benefit to all other
amputees alter two years of enactment of this act.

PRIOR LEGISLATIVE HISTORY: New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT: None

EFFECTIVE DATE: This act shall take effect May 1, 2015 and section 4-6
shall take effect on April 1, 2017.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5390--B

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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  --  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.    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
HOLDER.  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.
                                                           LBD10223-07-4

S. 5390--B                          2

AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJU-
RY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES.
  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 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
HOLDER.  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
AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJU-
RY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES.
  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 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
HOLDER.    THE  TERM  "PROSTHETIC  DEVICE"  AS  USED  IN THIS SUBSECTION
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 SUBSECTION SHALL
MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE OF NEW  YORK
AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED FROM AN INJU-
RY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED FORCES.
  S  4.  This  act  shall take effect May 1, 2015 and shall apply to all
policies and contracts issued, renewed, altered, or amended on or  after
such effective date.

S5390C (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A6820C
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L

S5390C (ACTIVE) - Bill Texts

view 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.

view sponsor memo
BILL NUMBER:S5390C

TITLE OF BILL: An act to amend the insurance law, in relation to
mandatory health insurance coverage for prosthetic devices

PURPOSE OR GENERAL IDEA OF THE BILL:

To ensure that coverage for rehabilitative and habilitative services,
including prosthetic devices, are available to military veterans
residing in NYS.

SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that health insurers that provide medical,
major, medical, or similar comprehensive type coverage and cover
durable medical equipment include coverage for prosthetic devices for
veterans of the armed forces who are residents of New York on parity
with the coverage for durable medical, equipment.

JUSTIFICATION:

Two recent wars involving the United States, Iraq and Afghanistan has
left over 600 military men and women as amputees with life-long
injuries. Each year 185,000 amputations occur in the US and there are
nearly 2 million people living with limb loss in the US. Improving
access to quality and updated prosthetic devices will improve the
quality of life of veterans and other amputees, while helping to
reduce other medical costs related to lack of mobility and associated
physical and emotional health.

According to the Veterans Health Administration, approximately 6
percent of wounded service members returning from Iraq are individuals
with amputations. As a society, we owe these veterans the best of our
efforts to help them live improved lives after their sacrifice for our
nation.

PRIOR LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:

None

EFFECTIVE DATE:

This act shall take effect May 1, 2015.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5390--C

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              May 16, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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  --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee --  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  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
OTHER ARTICLE CONSIDERED AS ORDINARY WEARING  APPAREL,  WHETHER  OR  NOT
SPECIALLY  CONSTRUCTED.   THE TERM "POLICY HOLDER" AS USED IN THIS PARA-
GRAPH SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE  STATE
OF  NEW  YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE RESULTED
FROM AN INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN  THE  ARMED
FORCES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10223-09-4

S. 5390--C                          2

  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 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
OTHER  ARTICLE  CONSIDERED  AS  ORDINARY WEARING APPAREL, WHETHER OR NOT
SPECIALLY CONSTRUCTED. THE TERM "POLICY HOLDER" AS USED  IN  THIS  PARA-
GRAPH  SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES IN THE STATE
OF NEW YORK AND WHOSE MEDICAL NEED FOR SUCH PROSTHETIC  DEVICE  RESULTED
FROM  AN  INJURY SUFFERED IN THE LINE OF DUTY WHILE SERVING IN THE ARMED
FORCES.
  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 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
SUBSECTION 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
SUBSECTION SHALL MEAN A VETERAN OF THE ARMED FORCES WHO RESIDES  IN  THE
STATE  OF  NEW  YORK  AND  WHOSE MEDICAL NEED FOR SUCH PROSTHETIC DEVICE
RESULTED FROM AN INJURY SUFFERED IN THE LINE OF DUTY  WHILE  SERVING  IN
THE ARMED FORCES.
  S  4.  This  act  shall take effect May 1, 2015 and shall apply to all
policies and contracts issued, renewed, altered, or amended on or  after
such effective date.

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