S. 3517 would amend the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to provide parity under group health plans and group health insurance coverage for the provision of benefits for prosthetic devices and components and benefits for other medical and surgical services.
Detailed Summary
Prosthetics Parity Act of 2008 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act to require a group health plan that provides both medical and surgical benefits and benefits for prosthetic devices and components to provide prosthetics coverage under terms and conditions that are no less favorable than those applicable to substantially all medical and surgical benefits provided under the plan.
Prohibits the prosthetics benefit from being subject to separate or more restrictive financial requirements or more restrictive treatment limitations.
Applies the requirements of this Act separately with respect to in-network and out-of-network benefits.
Requires a group health plan to apply the same prior authorization requirements to the prosthetics benefit as apply for all similar benefits under the plan.
Limits the required prosthetics benefit to the most appropriate device or component that adequately meets the medical requirements of the patient. Includes repair or replacement of prosthetic devices and components within such coverage.
Prohibits a group health plan from imposing any annual or lifetime dollar limitation on benefits for prosthetic devices and components required to be covered under this Act that is not applied in the aggregate to all medical and surgical benefits provided under the plan.
Requires the Secretary of Labor to: (1) assist enrollees with any questions or problems regarding compliance with the requirements of this Act; and (2) conduct random audits of group health plans to ensure compliance.
Requires the Comptroller General to evaluate the effects of this Act, including on the cost of and access to heath insurance coverage.
Status of the Legislation
Latest Major Action: 9/18/2008: Referred to Senate committee. Status: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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