NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4395
SPONSOR: Gunther 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
Section 2 of the bill amends Subsection (1) of Section 3221 of the
Insurance Law
Section 3 of the bill amends Section 4303 of the Insurance Law
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:
2021-22: A4120 referred to Insurance
2019-20: A3086 referred to Insurance/S7373 referred to Insurance
2017-18: A2212 referred to Insurance/S2080 referred to Insurance
2015-16: A1178C passed Assembly/S1708C referred to Insurance
2013-14: A1103-A held in Insurance/S3951-A referred to Insurance
2011-12: A497 referred to Insurance
2009-10: A770 Held in Insurance / S2893 referred to Insurance
2007-08: A1274 referred to / S1672 referred to Senate Insurance
2005-06: A450 referred to Insurance / S599 referred to Senate Insurance
2003-04: A9459 referred to insurance
2001-02: A10033B referred to Insurance / S4533B 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.
STATE OF NEW YORK
________________________________________________________________________
4395
2023-2024 Regular Sessions
IN ASSEMBLY
February 14, 2023
___________
Introduced by M. of A. GUNTHER, L. ROSENTHAL, DINOWITZ, ZEBROWSKI,
COLTON, SIMON, MIKULIN -- 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:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 39 to read as follows:
3 (39) Every policy which provides medical, major medical, or similar
4 comprehensive type coverage shall provide coverage for prosthetic
5 devices, including repairs and replacements, that are intended for
6 medically necessary rehabilitative and habilitative purposes as required
7 by 42 U.S.C. §18022. As such, prosthetic device coverage shall be
8 subject to annual deductibles and coinsurance as deemed appropriate by
9 the superintendent in amounts no greater than other essential health
10 benefits covered by the policy. The term "prosthetic device" as used in
11 this paragraph includes an artificial limb and all of the components and
12 related services that comprise prosthetic care but shall not include
13 shoes or any other article considered as ordinary wearing apparel,
14 whether or not specially constructed.
15 § 2. Subsection (l) of section 3221 of the insurance law is amended by
16 adding a new paragraph 22 to read as follows:
17 (22) Every policy which provides medical, major medical, or similar
18 comprehensive type coverage shall provide coverage for prosthetic
19 devices, including repairs and replacements, that are intended for
20 medically necessary rehabilitative and habilitative purposes as required
21 by 42 U.S.C. §18022. As such, prosthetic device coverage shall be
22 subject to annual deductibles and coinsurance as deemed appropriate by
23 the superintendent in amounts no greater than other essential health
24 benefits covered by the policy. The term "prosthetic device" as used in
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09046-01-3
A. 4395 2
1 this paragraph includes an artificial limb and all of the components and
2 related services that comprise prosthetic care but shall not include
3 shoes or any other article considered as ordinary wearing apparel,
4 whether or not specially constructed.
5 § 3. Section 4303 of the insurance law is amended by adding a new
6 subsection (qq) to read as follows:
7 (qq) Every policy which provides medical, major medical, or similar
8 comprehensive type coverage shall provide coverage for prosthetic
9 devices, including repairs and replacements, that are intended for
10 medically necessary rehabilitative and habilitative purposes as required
11 by 42 U.S.C. §18022. As such, prosthetic device coverage shall be
12 subject to annual deductibles and coinsurance as deemed appropriate by
13 the superintendent in amounts no greater than other essential health
14 benefits covered by the policy. The term "prosthetic device" as used in
15 this subsection includes an artificial limb and all of the components
16 and related services that comprise prosthetic care but shall not include
17 shoes or any other article considered as ordinary wearing apparel,
18 whether or not specially constructed.
19 § 4. This act shall take effect on the ninetieth day after it shall
20 have become a law and shall apply to policies and contracts issued,
21 renewed, modified, altered or amended on or after such effective date.
