What's happening
This bill requires New York health insurance policies to cover prosthetic devices, including repairs and replacements, for medically necessary rehabilitative and habilitative purposes.
Why it matters
Reduces financial barriers. for individuals needing prosthetic devices by requiring insurance to cover not just the devices, but also necessary repairs and replacements, which can be major recurring costs for amputees and others.
Aligns state law with federal standards. by referencing 42 U.S.C. §18022, ensuring coverage for “rehabilitative and habilitative purposes,” which expands the definition beyond injury recovery to include people with congenital or developmental limb differences.
Limits out-of-pocket costs. by mandating that deductibles and coinsurance for prosthetic devices cannot be higher than for other essential health benefits, preventing insurers from placing higher financial burdens specifically on prosthetic care.
Clarifies what is covered. by defining “prosthetic device” to include artificial limbs and all related services, but explicitly excludes ordinary shoes and regular clothing, which prevents potential disputes over what insurance must provide.
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Who cares
Headline styles
Cover Prosthetics With Insurance
Plain English, a few words. Used as the page title.
Sponsors
Senator · Senate District 42
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.
Require Insurance for Prosthetics
In Assembly Committee · Insurance · Sponsor Aileen Gunther
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2080
2017-2018 Regular Sessions
IN SENATE
January 12, 2017
Introduced by Sens. BONACIC, ADDABBO, AVELLA, BRESLIN, GALLIVAN, GOLDEN, LATIMER, RITCHIE, ROBACH -- read twice and ordered printed, and when printed to be committed 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 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03027-01-7
S. 2080 2
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.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to mandatory health insurance coverage for providing prosthetic devices
Purpose or general idea of bill
To provide mandatory coverage for prosthetic devices for children who periodically need to have these devices altered or replaced due to normal physical growth, for adults whose conditions change and to account for updated technology, repair and replacement.
Summary of specific provisions
In order to mandate coverage by health insurance providers for prosthetic devices:
Section 1 of the bill amends Subsection (i) of Section 3216 of the Insurance Law by adding a new paragraph 33
Section 2 of the bill amends Subsection (1) of Section 3221 of the Insurance Law by adding a new paragraph 19
Section 3 of the bill amends Section 4303 of the Insurance Law by adding anew subsection (qq)
Justification
Though not as common as in adults, children, even infants may need a prosthetic device due to the loss of a limb. The overwhelming experience for a child of losing a limb does not need to be compounded by a long battle to pay for treatment. This legislation will provide coverage to children and adults for prosthetic devices and to replace or change these devices as needed to account for natural growth and repairs of such devices.
Legislative history
2015-16: S1708C died in Senate Insurance 2013-14: S3951A died in Senate Insurance 2011-12: A497 died in Assembly Insurance 2009-10: A770 died in Assembly Insurance /S2893 died in Senate Insurance 2007-08: A1274 died in Assembly Insurance/ S1672 Died in Senate Insurance 2005-06: A450 died in Assembly Insurance /S599 died in Senate Insurance 2003-04: A9459 died in Assembly Insurance 2001-02: S4533B died in Senate Insurance
Fiscal implications
None to the state.
Effective date
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.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.