What's happening
This bill requires health insurance policies in New York to cover prosthetic devices, including repairs and replacements, for medically necessary purposes.
Why it matters
Expands access to prosthetic devices. by making it mandatory for all types of health insurance policies in New York (including individual, group, and HMOs) to cover artificial limbs and related prosthetic care if medically necessary, which can significantly improve quality of life for amputees and those needing such devices for rehabilitation or habilitation.
Limits out-of-pocket costs. for prosthetic devices by requiring insurers to treat cost-sharing (deductibles and coinsurance) for these devices no more restrictively than for other "essential health benefits," reducing financial barriers for those who need prosthetics.
Clarifies definitions and exclusions. by specifying that coverage must include all components and related services for prosthetic care, but explicitly excludes shoes or ordinary clothing—even if specially made—ensuring clarity about what is and isn’t covered.
Aligns state law with federal standards. by linking coverage requirements to the federal Affordable Care Act’s definition of essential health benefits (42 U.S.C. §18022), ensuring consistency and potentially protecting coverage from being undermined by future state-level policy changes.
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Who cares
Headline styles
Require Prosthetic Device Coverage
Plain English, a few words. Used as the page title.
Sponsors
15 Co-sponsors
History
- Print number 3086a
- Amend and recommit to insurance
- 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 Senate Committee · Insurance · Sponsor Jen Metzger
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3086--A
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. GUNTHER, ORTIZ, L. ROSENTHAL, JAFFEE, PERRY, DINOWITZ, ZEBROWSKI, RIVERA, COLTON, ABINANTI, DenDEKKER, M. G. MILL- ER, LALOR, SIMON, MIKULIN -- Multi-Sponsored by -- M. of A. ABBATE, BENEDETTO, COOK, CROUCH, CUSICK, GALEF, GIGLIO, GOTTFRIED, LUPARDO, MAGNARELLI, McDONOUGH, MONTESANO, PAULIN, THIELE -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
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 36 to read as follows:
(36) 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 21 to read as follows:
(21) Every policy which provides medical, major medical, or similar comprehensive type coverage shall provide coverage for prosthetic
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01454-02-0
A. 3086--A 2
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.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss) 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.