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STATE OF NEW YORK
1394
2003-2004 Regular Sessions
IN ASSEMBLY
January 21, 2003
Introduced by M. of A. GUNTHER -- 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
ASSEMBLY, DO ENACT AS FOLLOWS:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 25 to read as follows:
3 (25) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
4 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
5 MEDICARE`S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
6 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
7 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
8 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
9 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
10 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
11 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
12 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
13 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
14 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
15 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
16 S 2. Subsection (l) of section 3221 of the insurance law is amended by
17 adding a new paragraph 17 to read as follows:
18 (17) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
19 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
20 MEDICARE`S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
21 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
22 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
23 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
24 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
25 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
{ } is old law to be omitted.
LBD00526-01-3
A. 1394 2
1 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
2 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
3 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
4 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
5 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
6 S 3. Section 4303 of the insurance law is amended by adding a new
7 subsection (dd) to read as follows:
8 (DD) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
9 COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE EQUAL TO OR ABOVE
10 MEDICARE`S STANDARD OF COVERAGE FOR PROSTHETIC DEVICES. THIS SHALL
11 INCLUDE COVERAGE NOT ONLY FOR THE PROVISION OF A PROSTHETIC DEVICE
12 REQUIRED TO BE WORN OR USED BY A POLICY HOLDER BUT ALSO THE REPAIR OR
13 REPLACEMENT OF A PROSTHETIC DEVICE REQUIRED TO BE WORN OR USED BY A
14 POLICY HOLDER. COVERAGE SHALL INCLUDE EXPENSES FOR ASSESSMENT, EVALU-
15 ATION, TREATMENT, MANAGEMENT, AND FOLLOW-UP CARE. COVERAGE SHALL NOT BE
16 DENIED ON THE GROUND THAT IT IS FOR COSMETIC PURPOSES OR IS NOT FOR A
17 FUNCTIONAL DEFECT OR IMPAIRMENT. THE TERM "PROSTHETIC DEVICE" AS USED IN
18 THIS SECTION INCLUDES AN ARTIFICIAL LIMB OR ARTIFICIAL EYE BUT SHALL NOT
19 INCLUDE SHOES OR ANY OTHER ARTICLE CONSIDERED AS ORDINARY WEARING
20 APPAREL, WHETHER OR NOT SPECIALLY CONSTRUCTED.
21 S 4. This act shall take effect on the ninetieth day after it shall
22 have become a law and shall apply to policies and contracts issued,
23 renewed, modified, altered or amended on or after such effective date.
.SO DOC A 1394 *END* BTXT 2003
Relevant information:
A Report to the Joint Standing Committee on Insurance and Financial Services of the 121st
Maine Legislature
http://www.state.me.us/pfr/120_Legis/reports/ins_LD1353final.pdf
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