Senate Bill S5943A

2015-2016 Legislative Session

Requires mandatory health insurance coverage for prosthetic devices

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee Rules 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

co-Sponsors

2015-S5943 - Details

Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S704
2019-2020: S5174
2021-2022: S3649
2023-2024: S1315

2015-S5943 - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.

2015-S5943 - Sponsor Memo

2015-S5943 - Bill Text download pdf 

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

                                  5943

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              June 12, 2015
                               ___________

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

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 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 TO A POLICYHOLDER SHALL PROVIDE COVERAGE FOR
PROSTHETIC DEVICES THAT ARE INTENDED FOR MEDIALLY NECESSARY  REHABILITA-
TIVE  AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022. COVER-
AGE SHALL INCLUDE THE  COST  OF  REPAIR  OR  REPLACEMENT  OF  PROSTHETIC
DEVICES  DUE  TO  NORMAL  WEAR AND TEAR, IF A PROSTHETIC DEVICE HAS BEEN
OUTGROWN OR NO LONGER FITS PROPERLY, OR WHERE A CHANGE  IN  THE  MEDICAL
CONDITION  MAKES  REPLACEMENT  NECESSARY. COVERAGE SHALL NOT INCLUDE THE
COSTS OF REPAIR OR REPLACEMENT OF A PROSTHETIC DEVICE  THAT  IS  COVERED
UNDER  THE WARRANTY OF THE MANUFACTURE OR WHEN THE REPAIR OR REPLACEMENT
IS NECESSARY DUE TO MISUSE OR NEGLIGENCE. 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 SPECIFICALLY CONSTRUCTED. THE TERM "POLICYHOLD-
ER" 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 WHILE IN ACTIVE  DUTY
SERVING  IN  THE  ARMED FORCES. SUCH COVERAGE SHALL BE SUBJECT TO ANNUAL
DEDUCTIBLES 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 ESSENTIAL HEALTH BENEFIT COVERAGE CHOSEN  BY
THE STATE PURSUANT TO 45 CFR 156.100. NOTHING IN THIS PARAGRAPH SHALL BE
CONSTRUED  TO  PREVENT  THE  MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11641-01-5

co-Sponsors

2015-S5943A (ACTIVE) - Details

Current Committee:
Senate Rules
Law Section:
Insurance Law
Laws Affected:
Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:
2017-2018: S704
2019-2020: S5174
2021-2022: S3649
2023-2024: S1315

2015-S5943A (ACTIVE) - Summary

Requires mandatory health insurance coverage for prosthetic devices; requires coverage where the model is determined to be medically necessary for rehabilitative and habilitative purposes.

2015-S5943A (ACTIVE) - Sponsor Memo

2015-S5943A (ACTIVE) - Bill Text download pdf 

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

                                 5943--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              June 12, 2015
                               ___________

Introduced by Sens. ORTT, ADDABBO -- read twice and ordered printed, and
  when  printed to be committed to the Committee on Rules -- 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 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  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 TO A POLICYHOLDER SHALL PROVIDE COVERAGE FOR
PROSTHETIC  DEVICES THAT ARE INTENDED FOR MEDIALLY NECESSARY REHABILITA-
TIVE AND HABILITATIVE PURPOSES AS REQUIRED BY 42 U.S.C. S 18022.  COVER-
AGE  SHALL  INCLUDE  THE  COST  OF  REPAIR  OR REPLACEMENT OF PROSTHETIC
DEVICES DUE TO NORMAL WEAR AND TEAR, IF A  PROSTHETIC  DEVICE  HAS  BEEN
OUTGROWN  OR  NO  LONGER FITS PROPERLY, OR WHERE A CHANGE IN THE MEDICAL
CONDITION MAKES REPLACEMENT NECESSARY. COVERAGE SHALL  NOT  INCLUDE  THE
COSTS  OF  REPAIR  OR REPLACEMENT OF A PROSTHETIC DEVICE THAT IS COVERED
UNDER THE WARRANTY OF THE MANUFACTURE OR WHEN THE REPAIR OR  REPLACEMENT
IS  NECESSARY  DUE TO MISUSE OR NEGLIGENCE. 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 SPECIFICALLY CONSTRUCTED. THE TERM  "POLICYHOLD-
ER"  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 WHILE IN ACTIVE DUTY
SERVING IN THE ARMED FORCES. SUCH COVERAGE SHALL BE  SUBJECT  TO  ANNUAL
DEDUCTIBLES AND COINSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
THE COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE IDENTICAL TO, AND SHALL

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11641-02-6

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