S T A T E O F N E W Y O R K
________________________________________________________________________
497
2011-2012 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 5, 2011
___________
Introduced by M. of A. GUNTHER, PHEFFER, ORTIZ, ROSENTHAL, WRIGHT,
JAFFEE, JACOBS, PERRY, CLARK, HOOPER, KELLNER, SPANO, CALHOUN, McKEV-
ITT, DINOWITZ -- Multi-Sponsored by -- M. of A. ABBATE, BENEDETTO,
BING, CONTE, COOK, CROUCH, CUSICK, GALEF, GIGLIO, GOTTFRIED, LANCMAN,
LATIMER, MAGNARELLI, MAISEL, McENENY, J. MILLER, PAULIN, RAIA, REILLY,
J. RIVERA, SCHROEDER, SWEENEY, THIELE, WEISENBERG -- 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:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 28 to read as follows:
3 (28) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
4 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
5 MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
6 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
7 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
8 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
9 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
10 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
11 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
12 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
13 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
14 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
15 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
16 S 2. Subsection (l) of section 3221 of the insurance law is amended by
17 adding a new paragraph 18 to read as follows:
18 (18) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
19 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01490-01-1
A. 497 2
1 MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
2 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
3 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
4 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
5 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
6 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
7 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
8 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
9 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
10 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
11 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
12 S 3. Section 4303 of the insurance law is amended by adding a new
13 subsection (hh) to read as follows:
14 (HH) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
15 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
16 MEDICARE'S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
17 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
18 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
19 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
20 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
21 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
22 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
23 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
24 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
25 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
26 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
27 S 4. This act shall take effect on the ninetieth day after it shall
28 have become a law and shall apply to policies and contracts issued,
29 renewed, modified, altered or amended on or after such effective date.