What's happening
This bill requires insurance policies in New York to cover medically necessary prostheses for limb loss, with certain limitations and conditions.
Why it matters
Expands access to prosthetic devices. by requiring all major medical insurance policies (individual, group, and blanket plans) to cover prostheses when medically necessary for limb loss, ensuring that people who lose limbs due to accident, injury, or disease can obtain essential assistive devices.
Medical necessity safeguard. means coverage is only triggered when a licensed healthcare provider issues a written order stating the prosthesis is necessary to promote the patient's well-being or healing, potentially limiting unnecessary or elective use but ensuring physician oversight.
Coverage limitations and cost-sharing. are permitted: insurers can require deductibles and coinsurance similar to other policy benefits, and may restrict coverage to one prosthesis per person for the lifetime of the policy, which could impact individuals who need replacements due to growth, wear, or technological advancements.
Uniform statewide standard. for prosthetic coverage reduces disparities in insurance offerings and could improve quality of life, mobility, and employment prospects for amputees while also potentially increasing insurance premiums or administrative costs.
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Who cares
Headline styles
Require Prosthesis Insurance Coverage
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3857
2017-2018 Regular Sessions
IN ASSEMBLY
January 30, 2017
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 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) (A) Every individual policy which provides major medical or similar comprehensive-type coverage shall include coverage for the purchase of 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 that the treating physician or other licensed health care provider legally authorized to prescribe under title eight of the education law issues a written order for such purchase stating his or her opinion that such purchase is medically necessary to promote the patient's well-being or to promote the healing process.
(B) Such coverage may be subject to such annual deductibles and coinsurance as deemed appropriate by the superintendent and as are consistent with those required for other benefits under the policy. Such coverage may be limited to one prosthesis for the life of the policy.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) (A) Every group or blanket policy which provides major medical or similar comprehensive-type coverage shall include coverage for the purchase of prostheses which are necessary to compensate for the loss of a limb due to accident, injury or disease, or the treatment of such condition, provided that the treating physician or other licensed health care provider legally authorized to prescribe under title eight of the 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.
LBD06243-01-7
A. 3857 2
opinion that such purchase is medically necessary to promote the patient's well-being or to promote the healing process.
(B) Such coverage may be subject to such annual deductibles and coinsurance as deemed appropriate by the superintendent and as are consistent with those required for other benefits under the policy. Such coverage may be limited to one prosthesis per covered person for the lifetime of the policy.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows:
(oo)(1) Every contract issued by a corporation subject to the provisions of this article which provides major medical or similar comprehensive-type coverage, shall include coverage for the purchase of prostheses which are necessary to compensate for the loss of a limb as a result of accident, injury or disease, or the treatment of such condition, provided that the treating physician or other licensed health care provider legally authorized to prescribe under title eight of the education law, issues a written order for such purchase stating his or her opinion that such purchase is medically necessary to promote the patient's well-being or to promote the healing process.
(2) Such coverage may be subject to such annual deductibles and coinsurance as deemed appropriate by the superintendent and as are consistent with those required for other benefits under the policy. Such coverage may be limited to one prosthesis per covered person for the lifetime of the policy.
§ 4. This act shall take effect on the one hundred eightieth day after it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such 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.