Bill Text: NY S05943 | 2015-2016 | General Assembly | Amended

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Bill Title: Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.

Spectrum: Bipartisan Bill

Status: (Engrossed - Dead) 2016-06-17 - RECOMMITTED TO RULES [S05943 Detail]

Download: New_York-2015-S05943-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                         5943--A
                               2015-2016 Regular Sessions
                    IN SENATE
                                      June 12, 2015
                                       ___________
        Introduced by Sens. ORTT, ADDABBO -- read twice and ordered printed, and
          when  printed to be committed to the Committee on Rules -- 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 providing prosthetic devices
          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 33 to read as follows:
     3    (33) Every policy which provides medical, major  medical,  or  similar
     4  comprehensive type coverage to a policyholder shall provide coverage for
     5  prosthetic  devices that are intended for medially necessary rehabilita-
     6  tive and habilitative purposes as required by 42 U.S.C. § 18022.  Cover-
     7  age  shall  include  the  cost  of  repair  or replacement of prosthetic
     8  devices due to normal wear and tear, if a  prosthetic  device  has  been
     9  outgrown  or  no  longer fits properly, or where a change in the medical
    10  condition makes replacement necessary. Coverage shall  not  include  the
    11  costs  of  repair  or replacement of a prosthetic device that is covered
    12  under the warranty of the manufacture or when the repair or  replacement
    13  is  necessary  due to misuse or negligence. The term "prosthetic device"
    14  as used in this paragraph includes an artificial  limb,  but  shall  not
    15  include  shoes  or  any  other  article  considered  as ordinary wearing
    16  apparel, whether or not specifically constructed. The term  "policyhold-
    17  er"  as  used in this paragraph shall mean a veteran of the armed forces
    18  who resides in the state of New York and whose  medical  need  for  such
    19  prosthetic  device resulted from an injury suffered while in active duty
    20  serving in the armed forces. Such coverage shall be  subject  to  annual
    21  deductibles and coinsurance as deemed appropriate by the superintendent.
    22  The coverage required by this paragraph shall be identical to, and shall
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11641-02-6