H.R. 5615 would provide parity under group health plans and group health insurance coverage in the provision of benefits for prosthetic devices and components and benefits for other medical and surgical services.
Detailed Summary
Group Health Plan Prosthetics Parity Act of 2007 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) 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 model 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 the prosthetics benefit 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 participants and beneficiaries 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: 3/13/2008: Referred to House committee. Status: Referred to the House Committee on Education and Labor.
Points in Favor
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Points Against
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Visitor Comments
Scott
May 6, 2008, 7:47pm (report abuse)When is HR 5615 up for vote?
Concerned citizen
May 8, 2008, 8:42am (report abuse)I understand how the Group Health Plan Prosthetics Parity Act of 2007 - HR 5615 IH will help support the prosthetics industry, and provide prostheses to amputees whom otherwise would not be able to obtain them. The act however does not address the quality of care received, by whom (prosthetics is an unregulated industry in the majority of states), standards, or disclosure to the amputee about these services. Without addressing these points the proposed legislation would impact insurance companies negatively causing an increase in costs, and open the possibility of further injury to amputees increasing costs even further.