What's happening
This bill requires health insurance policies in New York to cover prosthetic devices for veterans injured in the line of duty.
Why it matters
Expands insurance coverage for veterans. by specifically mandating that New York health insurance policies cover prosthetic devices for veterans injured in the line of duty, ensuring this group receives necessary medical technology not always covered under general durable medical equipment provisions.
Prioritizes medical necessity and physician judgment. by requiring that coverage cannot be denied if a physician determines a particular prosthetic device is the most appropriate model to meet the veteran's specific medical needs—limiting insurer discretion and supporting individualized care.
Defines the scope of covered devices clearly. by specifying that “prosthetic device” includes artificial limbs but does not extend to shoes or regular clothing, even if specially made, which helps avoid disputes over what is covered and focuses resources on critical medical equipment.
Aligns state coverage standards with federal requirements. (42 U.S.C. § 18022), potentially reducing gaps in benefits and ensuring that veterans in New York receive a level of insurance support consistent with national guidelines for essential health benefits.
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
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
4259
2019-2020 Regular Sessions
IN SENATE
March 5, 2019
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 35 to read as follows:
(35) 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 21 to read as follows:
(21) 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.
LBD09464-01-9
S. 4259 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 (ss) to read as follows:
(ss) 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, 2021 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
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 inju- ries. 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
2017-18: S.2875 - REFERRED TO INSURANCE 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.