What's happening
This bill requires health insurance plans in New York to cover scalp hair prostheses for individuals with certain types of alopecia.
Why it matters
Addresses a significant gap in health coverage. by requiring insurance plans to cover medically necessary scalp hair prostheses for people with specific types of alopecia, acknowledging the mental and social health impacts of hair loss.
Removes financial barriers. for patients by stipulating that coverage for scalp hair prostheses cannot have less favorable terms (like higher deductibles or stricter dollar limits) than coverage for other prostheses—though insurers may cover only up to 80% of typical costs, exclusive of any deductible.
Standardizes medical necessity. by requiring a physician’s written certification, ensuring that only those with a documented clinical need (due to alopecia areata, totalis, or universalis) benefit from the mandated coverage, thus aiming to prevent misuse while supporting those most affected.
Applies to new and renewed policies. starting from the effective date, meaning that both current and future patients with group health coverage could benefit as their policies are issued or updated, potentially improving access for a broad population over time.
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Who cares
Headline styles
Cover Wigs for Hair Loss
Plain English, a few words. Used as the page title.
Sponsors
3 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1442
2017-2018 Regular Sessions
IN ASSEMBLY
January 12, 2017
Introduced by M. of A. CAHILL -- Multi-Sponsored by -- M. of A. ENGLE- BRIGHT, GALEF, PERRY -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain health insurance policies to cover costs for scalp hair prosthesis worn for hair loss suffered as a result of alopecia areata, alopecia totalis or alopecia universalis
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 34 to read as follows:
(34) (A) A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall provide coverage for scalp hair prosthesis for a participant or beneficiary who has scalp hair loss as a result of alopecia areata, alopecia totalis or alopecia universalis if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(B) As used in this paragraph, the term "scalp hair prosthesis" includes any artificial substitutes for scalp hair.
(C) The coverage required under this paragraph is not subject to dollar limits, deductibles, and coinsurance provisions that are less favorable than those for other prosthesis coverage under the plan or coverage, except that a group health plan or health insurance issuer may provide that the plan or issuer will only pay for eighty percent of the customary and usual costs of the scalp hair prosthesis exclusive of any deductible.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) (A) A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01394-01-7
A. 1442 2
provide coverage for scalp hair prosthesis for a participant or beneficiary who has scalp hair loss as a result of alopecia areata, alopecia totalis or alopecia universalis if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(B) As used in this paragraph, the term "scalp hair prosthesis" includes any artificial substitutes for scalp hair.
(C) The coverage required under this paragraph is not subject to dollar limits, deductibles, and coinsurance provisions that are less favorable than those for other prosthesis coverage under the plan or coverage, except that a group health plan or health insurance issuer may provide that the plan or issuer will only pay for eighty percent of the customary and usual costs of the scalp hair prosthesis exclusive of any deductible.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows:
(oo) (1) A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall provide coverage for scalp hair prosthesis for a participant or beneficiary who has scalp hair loss as a result of alopecia areata, alopecia totalis or alopecia universalis if the attending physician of the participant or beneficiary certifies in writing the medical necessity of that proposed course of rehabilitative treatment.
(2) As used in this subsection, the term "scalp hair prosthesis" includes any artificial substitutes for scalp hair.
(3) The coverage required under this subsection is not subject to dollar limits, deductibles, and coinsurance provisions that are less favorable than those for other prosthesis coverage under the plan or coverage, except that a group health plan or health insurance issuer may provide that the plan or issuer will only pay for eighty percent of the customary and usual costs of the scalp hair prosthesis exclusive of any deductible.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply according to its terms to all policies, contracts and certificates issued, renewed, modified, altered or amended on or after such effective date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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