Bill Text: NY A00951 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to insurance coverage for 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 a treating physician issues a written order for such purchase stating that such purchase is medically necessary to promote the patient's well-being or to promote the healing process.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A00951 Detail]

Download: New_York-2015-A00951-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                          951
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                    January 8, 2015
                                      ___________
       Introduced  by  M. of A. CYMBROWITZ, TITONE -- 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:
    1    Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
    2  amended by adding a new paragraph 32 to read as follows:
    3    (32) (A) EVERY INDIVIDUAL POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMI-
    4  LAR COMPREHENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR THE  PURCHASE
    5  OF  PROSTHESES  WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF A LIMB
    6  DUE TO ACCIDENT, INJURY OR DISEASE OR THE TREATMENT OF SUCH  CONDITIONS,
    7  PROVIDED  THAT  THE  TREATING  PHYSICIAN  OR  OTHER LICENSED HEALTH CARE
    8  PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCA-
    9  TION LAW ISSUES A WRITTEN ORDER FOR SUCH PURCHASE  STATING  HIS  OR  HER
   10  OPINION  THAT  SUCH  PURCHASE  IS  MEDICALLY  NECESSARY  TO  PROMOTE THE
   11  PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS.
   12    (B) SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND  COIN-
   13  SURANCE  AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSIST-
   14  ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER-
   15  AGE MAY BE LIMITED TO ONE PROSTHESIS FOR THE LIFE OF THE POLICY.
   16    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   17  adding a new paragraph 20 to read as follows:
   18    (20) (A) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MAJOR MEDICAL OR
   19  SIMILAR COMPREHENSIVE-TYPE  COVERAGE  SHALL  INCLUDE  COVERAGE  FOR  THE
   20  PURCHASE OF PROSTHESES WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF
   21  A  LIMB  DUE  TO  ACCIDENT,  INJURY OR DISEASE, OR THE TREATMENT OF SUCH
   22  CONDITION, PROVIDED THAT THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH
   23  CARE PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT  OF  THE
   24  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.
                                                                  LBD00236-02-5
       A. 951                              2
    1  OPINION  THAT  SUCH  PURCHASE  IS  MEDICALLY  NECESSARY  TO  PROMOTE THE
    2  PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS.
    3    (B)  SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND COIN-
    4  SURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE  CONSIST-
    5  ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER-
    6  AGE MAY BE LIMITED TO ONE PROSTHESIS PER COVERED PERSON FOR THE LIFETIME
    7  OF THE POLICY.
    8    S  3.  Section  4303  of  the insurance law is amended by adding a new
    9  subsection (pp) to read as follows:
   10    (PP)(1)  EVERY  CONTRACT  ISSUED  BY  A  CORPORATION  SUBJECT  TO  THE
   11  PROVISIONS  OF  THIS  ARTICLE  WHICH  PROVIDES  MAJOR MEDICAL OR SIMILAR
   12  COMPREHENSIVE-TYPE COVERAGE, SHALL INCLUDE COVERAGE FOR THE PURCHASE  OF
   13  PROSTHESES WHICH ARE NECESSARY TO COMPENSATE FOR THE LOSS OF A LIMB AS A
   14  RESULT  OF  ACCIDENT, INJURY OR DISEASE, OR THE TREATMENT OF SUCH CONDI-
   15  TION, PROVIDED THAT THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE
   16  PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCA-
   17  TION LAW, ISSUES A WRITTEN ORDER FOR SUCH PURCHASE STATING  HIS  OR  HER
   18  OPINION  THAT  SUCH  PURCHASE  IS  MEDICALLY  NECESSARY  TO  PROMOTE THE
   19  PATIENT'S WELL-BEING OR TO PROMOTE THE HEALING PROCESS.
   20    (2) SUCH COVERAGE MAY BE SUBJECT TO SUCH ANNUAL DEDUCTIBLES AND  COIN-
   21  SURANCE  AS DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSIST-
   22  ENT WITH THOSE REQUIRED FOR OTHER BENEFITS UNDER THE POLICY. SUCH COVER-
   23  AGE MAY BE LIMITED TO ONE PROSTHESIS PER COVERED PERSON FOR THE LIFETIME
   24  OF THE POLICY.
   25    S 4. This act shall take effect on the one hundred eightieth day after
   26  it shall have become a law and shall apply according to its terms to all
   27  policies, contracts and certificates issued, renewed, modified,  altered
   28  or amended on or after such date.