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