Group Health Plan Prosthetics Parity Act of 2007

To 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.

3/13/2008--Introduced.
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.


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Sponsor

• Rep. Robert Andrews [D, NJ-1]
• and 26 Co-Sponsors
  • Rep. Bruce Braley [D, IA-1]
  • Rep. André Carson [D, IN-7]
  • Rep. William Clay [D, MO-1]
  • Rep. Howard Coble [R, NC-6]
  • Rep. Joe Courtney [D, CT-2]
  • Rep. Lincoln Diaz-Balart [R, FL-21]
  • Rep. Mario Diaz-Balart [R, FL-25]
  • Rep. Michael Doyle [D, PA-14]
  • Rep. Bob Filner [D, CA-51]
  • Luis Fortuño
  • Rep. Gabrielle Giffords [D, AZ-8]
  • Rep. Raul Grijalva [D, AZ-7]
  • Rep. Peter King [R, NY-3]
  • Rep. Nita Lowey [D, NY-18]
  • Rep. Carolyn Maloney [D, NY-14]
  • Rep. George Miller [D, CA-7]
  • Rep. Jerrold Nadler [D, NY-8]
  • Rep. Donald Payne [D, NJ-10]
  • Rep. Todd Platts [R, PA-19]
  • Rep. Timothy Ryan [D, OH-17]
  • Rep. Lee Terry [R, NE-2]
  • Rep. John Tierney [D, MA-6]
  • Rep. Christopher Van Hollen [D, MD-8]
  • Rep. Zach Wamp [R, TN-3]
  • Rep. Maxine Waters [D, CA-35]
  • Rep. Peter Welch [D, VT-0]
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Committees

• House Education and Labor

Amendments

This bill has no amendments.

Amendments to H.R.5615

Number	Status	Purpose

Bill Status

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Introduced		Voted on by House		Voted on by Senate		Considered By President		Bill Becomes Law
March 13, 2008

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All Bill Actions

• Introduced on Mar 13, 2008.
• Mar 13, 2008: Referred to the House Committee on Education and Labor.

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Related Issue Areas:

• Health policy
• Access to health care
• Administrative remedies
• Auditing
• 21 more
• Civil rights
• Coinsurance
• Congress
• Congressional investigations
• Congressional reporting requirements
• Department of Labor
• Discrimination in insurance
• Discrimination in medical care
• Employee health benefits
• Executive departments
• Finance
• Government information
• Government publicity
• Health insurance
• Labor
• Law
• Medical care
• Medical economics
• Medicine
• Prosthesis
• Quality of care

Data from the Congressional Research Service

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Blog Coverage

March 17, 2009 Outsource Marketing Solutions blog: Lobbying for Arms and Legs

WASHINGTON -- Sean Brame looks bored. He's leaning forward to look down the length of the long, glass covered table, resting his cheek on his right wrist, where the doctors had to cut off his hand three years ago. Three...

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March 17, 2009 Advocates call for enhanced prosthetic insurance : Covering Health

Advocates call for enhanced prosthetic insurance. Mar. 17th, 2009 by Andrew Van Dam Filed under: Government. Unlike Medicare or Medicaid, private insurers often cap annual coverage for prosthetics. In recent years, some insurers have ...

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Source: Covering Health

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March 17, 2009 Outsource Marketing Solutions blog: Foot For Tyler

(Saginaw, MI) The Saginaw Spirit Hockey Club and Michigan Orthopedic Services have partnered for a very special presentation taking place at this Saturday's home game. Twelve year old Tyler Adams and his dad Scott will be honored at ...

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