S T A T E O F N E W Y O R K
________________________________________________________________________
4395
2023-2024 Regular Sessions
I N A S S E M B L Y
February 14, 2023
___________
Introduced by M. of A. GUNTHER, L. ROSENTHAL, DINOWITZ, ZEBROWSKI,
COLTON, SIMON, MIKULIN -- read once and referred to the Committee on
Insurance
AN ACT to amend the insurance law, in relation to mandatory health
insurance coverage for providing 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 39 to read as follows:
(39) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PROSTHETIC
DEVICES, INCLUDING REPAIRS AND REPLACEMENTS, THAT ARE INTENDED FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY 42 U.S.C. §18022. AS SUCH, PROSTHETIC DEVICE COVERAGE SHALL BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY
THE SUPERINTENDENT IN AMOUNTS NO GREATER THAN OTHER ESSENTIAL HEALTH
BENEFITS COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS PARAGRAPH INCLUDES AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS AND
RELATED SERVICES THAT COMPRISE PROSTHETIC CARE BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 22 to read as follows:
(22) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PROSTHETIC
DEVICES, INCLUDING REPAIRS AND REPLACEMENTS, THAT ARE INTENDED FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY 42 U.S.C. §18022. AS SUCH, PROSTHETIC DEVICE COVERAGE SHALL BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY
THE SUPERINTENDENT IN AMOUNTS NO GREATER THAN OTHER ESSENTIAL HEALTH
BENEFITS COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED IN
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09046-01-3
A. 4395 2
THIS PARAGRAPH INCLUDES AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS AND
RELATED SERVICES THAT COMPRISE PROSTHETIC CARE BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (qq) to read as follows:
(QQ) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE TYPE COVERAGE SHALL PROVIDE COVERAGE FOR PROSTHETIC
DEVICES, INCLUDING REPAIRS AND REPLACEMENTS, THAT ARE INTENDED FOR
MEDICALLY NECESSARY REHABILITATIVE AND HABILITATIVE PURPOSES AS REQUIRED
BY 42 U.S.C. §18022. AS SUCH, PROSTHETIC DEVICE COVERAGE SHALL BE
SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY
THE SUPERINTENDENT IN AMOUNTS NO GREATER THAN OTHER ESSENTIAL HEALTH
BENEFITS COVERED BY THE POLICY. THE TERM "PROSTHETIC DEVICE" AS USED IN
THIS SUBSECTION INCLUDES AN ARTIFICIAL LIMB AND ALL OF THE COMPONENTS
AND RELATED SERVICES THAT COMPRISE PROSTHETIC CARE BUT SHALL NOT INCLUDE
SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING APPAREL,
WHETHER OR NOT SPECIALLY CONSTRUCTED.
§ 4. This act shall take effect on the ninetieth day after it shall
have become a law and shall apply to policies and contracts issued,
renewed, modified, altered or amended on or after such effective date.