What's happening
This bill requires health insurance policies in New York to cover medically necessary prosthetic devices, including repairs and replacements.
Why it matters
Expands access and financial protection for people needing prosthetic devices. by ensuring insurance must cover not just initial devices, but also necessary repairs and replacements, reducing out-of-pocket costs for ongoing care.
Explicitly includes both rehabilitative and habilitative needs,. meaning coverage is not limited to restoring lost function but also supporting people with congenital or developmental differences, broadening who benefits from the law.
Limits cost-sharing (deductibles and coinsurance) for prosthetic devices. so they cannot be higher than for other essential health benefits, which helps prevent insurers from shifting disproportionate costs onto patients needing prosthetics.
Defines what qualifies as a prosthetic device. (including artificial limbs and related services, but excluding ordinary footwear), providing clarity for patients, providers, and insurers, and reducing disputes over what must be covered.
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Who cares
People who need prosthetic devices
The bill would require coverage for medically necessary rehabilitative and habilitative prosthetic care, including repairs, replacements, components and related services, but not shoes or ordinary apparel.
Health insurers
The bill would require comprehensive medical policies to cover prosthetic devices with annual deductibles and coinsurance no greater than those for other covered essential health benefits.
Prosthetic care providers
The coverage requirement would include artificial limbs and the components and related services that make up prosthetic care.
State insurance superintendent
The bill would give the superintendent responsibility for determining appropriate annual deductibles and coinsurance within the stated limits.
Headline styles
Require Insurance for Prosthetics
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- 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 Prosthetic Device Coverage
In Assembly Committee · Insurance · Sponsor Aileen Gunther
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7373
IN SENATE
January 22, 2020
Introduced by Sen. METZGER -- 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 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 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.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01454-03-0
S. 7373 2
§ 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.
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 devises 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 prosthet- ic devices:
Section 1 of the bill amends Subsection (i) of Section 3216 of the Insurance Law by adding a new paragraph 35
Section 2 of the bill amends Subsection (1) of Section 3221 of the Insurance Law by adding a new paragraph 21
Section 3 of the bill amends Section 4303 of the Insurance Law by adding a new subsection (ss)
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
2017-18: S.2080 (Bonacic) - referred to insurance 2015-16: S.1708-C (Bonacic)- referred to insurance 2013-14: S.3951-A (Bonacic)- referred to insurance 2009-10: S.2893 (Bonacic)- referred to insurance 2007-08: S.1672 (Bonacic)- referred to insurance 2005-06: 5.599 (Bonacic)- referred to 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.