S 4215: 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.

  
  STATE OF NEW YORK ________________________________________________________________________ 4215 2025-2026 Regular Sessions  IN SENATE February 3, 2025 ___________ Introduced by Sen. PARKER -- 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: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 40 to read as follows: 3 (40) Every policy which provides medical, major medical, or similar 4 comprehensive type coverage and provides coverage for durable medical 5 equipment shall provide coverage for prosthetic devices that are 6 intended for medically necessary rehabilitative and habilitative 7 purposes as required by 42 U.S.C. § 18022 that is equivalent to the 8 coverage provided for durable medical equipment. Coverage shall not be 9 denied if the policy holder's physician determines the prosthetic device 10 is the most appropriate model that adequately meets the medical needs of 11 the policy holder. The term "prosthetic device" as used in this para- 12 graph includes an artificial limb but shall not include shoes or any 13 other article considered as ordinary wearing apparel, whether or not 14 specially constructed. The term "policy holder" as used in this para- 15 graph shall mean a veteran of the armed forces who resides in the state 16 of New York and whose medical need for such prosthetic device resulted 17 from an injury suffered in the line of duty while serving in the armed 18 forces. 19 § 2. Subsection (l) of section 3221 of the insurance law is amended by 20 adding a new paragraph 23 to read as follows: 21 (23) Every policy which provides medical, major medical, or similar 22 comprehensive type coverage and provides coverage for durable medical 23 equipment shall provide coverage for prosthetic devices that are 24 intended for medically necessary rehabilitative and habilitative 25 purposes as required by 42 U.S.C. § 18022 that is equivalent to the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07836-01-5 
 S. 4215 2 1 coverage provided for durable medical equipment. Coverage shall not be 2 denied if the policy holder's physician determines the prosthetic device 3 is the most appropriate model that adequately meets the medical needs of 4 the policy holder. The term "prosthetic device" as used in this para- 5 graph includes an artificial limb but shall not include shoes or any 6 other article considered as ordinary wearing apparel, whether or not 7 specially constructed. The term "policy holder" as used in this para- 8 graph shall mean a veteran of the armed forces who resides in the state 9 of New York and whose medical need for such prosthetic device resulted 10 from an injury suffered in the line of duty while serving in the armed 11 forces. 12 § 3. Section 4303 of the insurance law is amended by adding a new 13 subsection (ww) to read as follows: 14 (ww) Every policy which provides medical, major medical, or similar 15 comprehensive type coverage and provides coverage for durable medical 16 equipment shall provide coverage for prosthetic devices that are 17 intended for medically necessary rehabilitative and habilitative 18 purposes as required by 42 U.S.C. § 18022 that is equivalent to the 19 coverage provided for durable medical equipment. Coverage shall not be 20 denied if the policy holder's physician determines the prosthetic device 21 is the most appropriate model that adequately meets the medical needs of 22 the policy holder. The term "prosthetic device" as used in this 23 subsection includes an artificial limb but shall not include shoes or 24 any other article considered as ordinary wearing apparel, whether or not 25 specially constructed. The term "policy holder" as used in this 26 subsection shall mean a veteran of the armed forces who resides in the 27 state of New York and whose medical need for such prosthetic device 28 resulted from an injury suffered in the line of duty while serving in 29 the armed forces. 30 § 4. This act shall take effect May 1, 2027 and shall apply to all 31 policies and contracts issued, renewed, altered, or amended on or after 32 such effective date.