Senate Bill S5350B

2015-2016 Legislative Session

Requires mandatory health insurance coverage for prosthetic devices

download bill text pdf

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Archive: Last Bill Status - In Senate Committee Insurance Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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Bill Amendments

2015-S5350 - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2013-2014: S5390
2017-2018: S2875
2019-2020: S4259
2021-2022: S4801
2023-2024: S6039

2015-S5350 - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

2015-S5350 - Sponsor Memo

2015-S5350 - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5350

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              May 13, 2015
                               ___________

Introduced  by  Sen.  ORTT  --  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 ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 32 to read as follows:
  (32)  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. S 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 PARA-
GRAPH 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  PARA-
GRAPH  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.
  S 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 19 to read as follows:
  (19) 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. S 18022  THAT  IS  EQUIVALENT  TO  THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06364-03-5
              

2015-S5350A - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2013-2014: S5390
2017-2018: S2875
2019-2020: S4259
2021-2022: S4801
2023-2024: S6039

2015-S5350A - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

2015-S5350A - Sponsor Memo

2015-S5350A - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5350--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              May 13, 2015
                               ___________

Introduced  by  Sen.  ORTT  --  read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  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 prosthetic devices

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
amended by adding a new paragraph 32 to read as follows:
  (32) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR  MEDICAL,  OR  SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES THAT ARE INTENDED FOR  MEDICALLY  NECESSARY  REHABILITATIVE  AND
HABILITATIVE  PURPOSES  AS REQUIRED BY 42 U.S.C. S 18022. COVERAGE SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE ADEQUATELY MEETS THE  MEDICAL  NEEDS  OF  THE  POLICY  HOLDER  IN
COMPLIANCE  WITH  THE  AGE,  DISABILITY  AND  EXPECTED  LENGTH  OF  LIFE
ANTI-DISCRIMINATION REQUIREMENTS OF 42 U.S.C. S 18022 (B)(4)(B) AND  THE
REQUIREMENT TO CONSIDER THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
POPULATION,  INCLUDING  PERSONS WITH DISABILITIES, PURSUANT TO 42 U.S.C.
S 18022 (B)(4)(C). THE TERM "PROSTHETIC DEVICE" AS USED  IN  THIS  PARA-
GRAPH  INCLUDES  AN  ARTIFICIAL  LIMB BUT SHALL NOT INCLUDE SHOES OR ANY
OTHER ARTICLE CONSIDERED AS ORDINARY WEARING  APPAREL,  WHETHER  OR  NOT
SPECIALLY  CONSTRUCTED. SUCH COVERAGE SHALL BE SUBJECT TO ANNUAL DEDUCT-
IBLES AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.   THE
COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL NOT
ENHANCE  OR  INCREASE  THE COVERAGE REQUIRED AS PART OF ESSENTIAL HEALTH
BENEFITS AS REQUIRED PURSUANT TO SECTION 2707(A) OF  THE  PUBLIC  HEALTH
SERVICES  ACT  42 U.S.C. S 300 GG-6(A). 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06364-05-5
              

2015-S5350B (ACTIVE) - Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2013-2014: S5390
2017-2018: S2875
2019-2020: S4259
2021-2022: S4801
2023-2024: S6039

2015-S5350B (ACTIVE) - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to adequately meet the medical needs of the policy holder.

2015-S5350B (ACTIVE) - Sponsor Memo

2015-S5350B (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5350--B

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              May 13, 2015
                               ___________

Introduced  by  Sen.  ORTT  --  read twice and ordered printed, and when
  printed to be committed to the Committee  on  Insurance  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to  said  committee  --  recommitted  to the Committee on Insurance in
  accordance with Senate Rule 6, sec. 8 --  committee  discharged,  bill
  amended,  ordered reprinted as amended and recommitted to said commit-
  tee

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 ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 33 to read as follows:
  (33)  EVERY  POLICY  WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE  TYPE  COVERAGE  SHALL  PROVIDE  COVERAGE  FOR  PROSTHETIC
DEVICES  THAT  ARE  INTENDED  FOR MEDICALLY NECESSARY REHABILITATIVE AND
HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022.  COVERAGE  SHALL
NOT BE DENIED IF THE POLICY HOLDER'S PHYSICIAN DETERMINES THE PROSTHETIC
DEVICE  ADEQUATELY  MEETS  THE  MEDICAL  NEEDS  OF  THE POLICY HOLDER IN
COMPLIANCE  WITH  THE  AGE,  DISABILITY  AND  EXPECTED  LENGTH  OF  LIFE
ANTI-DISCRIMINATION  REQUIREMENTS OF 42 U.S.C. S 18022 (B)(4)(B) AND THE
REQUIREMENT TO CONSIDER THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
POPULATION, INCLUDING PERSONS WITH DISABILITIES, PURSUANT TO  42  U.S.C.
S  18022  (B)(4)(C).  THE TERM "PROSTHETIC DEVICE" AS USED IN THIS PARA-
GRAPH INCLUDES AN ARTIFICIAL LIMB BUT SHALL NOT  INCLUDE  SHOES  OR  ANY
OTHER  ARTICLE  CONSIDERED  AS  ORDINARY WEARING APPAREL, WHETHER OR NOT
SPECIALLY CONSTRUCTED. SUCH COVERAGE SHALL BE SUBJECT TO ANNUAL  DEDUCT-
IBLES  AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.  THE
COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL NOT
ENHANCE OR INCREASE THE COVERAGE REQUIRED AS PART  OF  ESSENTIAL  HEALTH
BENEFITS  AS  REQUIRED  PURSUANT TO SECTION 2707(A) OF THE PUBLIC HEALTH
SERVICES ACT 42 U.S.C. S 300 GG-6(A). 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

              

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