What's happening
This bill requires New York health insurance policies to cover prosthetic devices for veterans injured in the line of duty.
Why it matters
Expands insurance coverage specifically for veterans injured in the line of duty. , ensuring they are not denied medically necessary prosthetic devices if their physician deems a particular model most appropriate—potentially improving quality of life and access to advanced prosthetics.
Aligns coverage standards for prosthetic devices with those for durable medical equipment. , meaning insurers must provide at least the same level of financial support for prosthetics as they do for other essential medical equipment, reducing out-of-pocket costs for affected veterans.
Clarifies that only artificial limbs (not shoes or typical clothing, even if specially constructed) are covered. , which helps set clear expectations for both veterans and insurers about what devices are eligible under this mandate.
Targets a specific population—New York resident veterans injured in the line of duty—rather than a broader group. , which may address a significant gap for those who may not qualify for or receive adequate federal VA benefits, but does not extend to non-veteran amputees or other groups needing prosthetics.
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Who cares
Headline styles
Cover Prosthetics for Veterans
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2875
2017-2018 Regular Sessions
IN SENATE
January 18, 2017
Introduced by Sen. PARKER -- 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 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 and provides coverage for durable medical equipment shall provide coverage for prosthetic devices that are intended for medically necessary rehabilitative and habilitative purposes as required by 42 U.S.C. § 18022 that is equivalent to the coverage provided for durable medical equipment. Coverage shall not be denied if the policy holder's physician determines the prosthetic device is the most appropriate model that adequately meets the medical needs of the policy holder. The term "prosthetic device" as used in this paragraph includes an artificial limb but shall not include shoes or any other article considered as ordinary wearing apparel, whether or not specially constructed. The term "policy holder" as used in this paragraph shall mean a veteran of the armed forces who resides in the state of New York and whose medical need for such prosthetic device resulted from an injury suffered in the line of duty while serving in the armed forces.
§ 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 and provides coverage for durable medical equipment shall provide coverage for prosthetic devices that are intended for medically necessary rehabilitative and habilitative purposes as required by 42 U.S.C. § 18022 that is equivalent to the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07398-01-7
S. 2875 2
coverage provided for durable medical equipment. Coverage shall not be denied if the policy holder's physician determines the prosthetic device is the most appropriate model that adequately meets the medical needs of the policy holder. The term "prosthetic device" as used in this paragraph includes an artificial limb but shall not include shoes or any other article considered as ordinary wearing apparel, whether or not specially constructed. The term "policy holder" as used in this paragraph shall mean a veteran of the armed forces who resides in the state of New York and whose medical need for such prosthetic device resulted from an injury suffered in the line of duty while serving in the armed forces.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows:
(oo) Every policy which provides medical, major medical, or similar comprehensive type coverage and provides coverage for durable medical equipment shall provide coverage for prosthetic devices that are intended for medically necessary rehabilitative and habilitative purposes as required by 42 U.S.C. § 18022 that is equivalent to the coverage provided for durable medical equipment. Coverage shall not be denied if the policy holder's physician determines the prosthetic device is the most appropriate model that adequately meets the medical needs of the policy holder. The term "prosthetic device" as used in this subsection includes an artificial limb but shall not include shoes or any other article considered as ordinary wearing apparel, whether or not specially constructed. The term "policy holder" as used in this subsection shall mean a veteran of the armed forces who resides in the state of New York and whose medical need for such prosthetic device resulted from an injury suffered in the line of duty while serving in the armed forces.
§ 4. This act shall take effect May 1, 2019 and shall apply to all policies and contracts issued, renewed, 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 prosthetic devices
Purpose or general idea of the bill
To ensure that coverage for rehabilitative and habilitative services, including prosthetic devices, are available to military veterans residing in NYS.
Summary of specific provisions
This bill would require that health insurers that provide medical, major, medical, or similar comprehensive type coverage and cover durable medical equipment include coverage for prosthetic devices for veterans of the armed forces who are residents of New York on parity with the coverage for durable medical, equipment.
Justification
Two recent wars involving the United States, Iraq and Afghanistan has left over 600 military men and women as amputees with life-long injuries. Each year 185,000 amputations occur in the US and there are nearly 2 million people living with limb loss in the US. Improving access to quality and updated prosthetic devices will improve the quality of life of veterans and other amputees, while helping to reduce other medical costs related to lack of mobility and associated physical and emotional health.
According to the Veterans Health Administration, approximately 6 percent of wounded service members returning from Iraq are individuals with amputations. As a society, we owe these veterans the best of our efforts to help them live improved lives after their sacrifice for our nation.
Prior legislative history
2015-16: S.2574A - Amend and Recommit to Insurance 2013-14: S.5390C/A.6820C - Referred to Insurance/Passed Assembly
Fiscal implications for state and local government
None
Effective date
This act shall take effect May 1, 2019.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.