S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4120
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 1, 2021
                                ___________
 
 Introduced  by  M. of A. GUNTHER, L. ROSENTHAL, PERRY, DINOWITZ, ZEBROW-
   SKI, J. RIVERA, COLTON, ABINANTI, SIMON, LALOR, MIKULIN -- Multi-Spon-
   sored  by  --  M.  of  A.  ABBATE,  BENEDETTO,  COOK,  CUSICK,  GALEF,
   J. M. GIGLIO,  GOTTFRIED,  LUPARDO,  MAGNARELLI, McDONOUGH, MONTESANO,
   PAULIN, THIELE -- read once and referred 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 ASSEM-
 BLY, 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02480-01-1

 A. 4120                             2
 
 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.