What's happening
This bill requires health insurance policies in New York to cover medically necessary prosthetic devices, including repairs and replacements.
Why it matters
Ensures consistent access to prosthetic devices for people with limb loss or limb difference. , as all major health insurance policies in New York would be required to cover not just initial prosthetics, but also necessary repairs and replacements. This means fewer financial barriers for patients needing ongoing prosthetic care.
Aligns state insurance coverage with federal standards (42 U.S.C. §18022). , tying prosthetic device coverage to the definition of "essential health benefits" under federal law. This offers legal clarity and helps prevent insurers from imposing stricter limits on prosthetic coverage than on other health benefits.
Limits out-of-pocket costs for patients. by stating that deductibles and coinsurance for prosthetic devices cannot be higher than those for other essential health benefits in a given policy. This provision helps protect individuals from disproportionate cost-sharing for medically necessary prosthetic care.
Clearly defines what constitutes a prosthetic device for insurance purposes. , explicitly including artificial limbs and related services but excluding ordinary shoes or regular clothing, even if specially made. This helps both insurers and patients understand what is (and isn't) covered, potentially reducing disputes over coverage.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Require Insurance for Prosthetics
Plain English, a few words. Used as the page title.
Sponsors
15 Co-sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Prosthetics With Insurance
In Senate Committee · Insurance · Sponsor John J. Bonacic
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2212
2017-2018 Regular Sessions
IN ASSEMBLY
January 17, 2017
Introduced by M. of A. GUNTHER, ORTIZ, ROSENTHAL, JAFFEE, PERRY, HOOPER, DINOWITZ, ZEBROWSKI, TITONE, RIVERA, ABINANTI, COLTON, DenDEKKER, M. G. MILLER, McKEVITT, RAIA, SALADINO, LALOR -- Multi-Sponsored by -- M. of A. ABBATE, BENEDETTO, COOK, CROUCH, CUSICK, GALEF, GIGLIO, GOTTFRIED, LUPARDO, MAGNARELLI, McDONOUGH, MONTESANO, PAULIN, SKARTA- DOS, THIELE -- 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 Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 34 to read as follows:
(34) 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 20 to read as follows:
(20) 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03027-01-7
A. 2212 2
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.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (rr) to read as follows:
(rr) 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.