S T A T E O F N E W Y O R K
________________________________________________________________________
591
2009-2010 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 7, 2009
___________
Introduced by M. of A. CAHILL, ENGLEBRIGHT, KOON -- Multi-Sponsored by
-- M. of A. BRENNAN, CANESTRARI, GALEF, McENENY, 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 ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 26 to read as follows:
(26) (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 BENEFI-
CIARY 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.
S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00649-01-9
A. 591 2
(15) (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 BENEFI-
CIARY 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.
S 3. Section 4303 of the insurance law is amended by adding a new
subsection (ff) to read as follows:
(FF) (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 BENEFI-
CIARY 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.
S 4. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law and shall apply accord-
ing to its terms to all policies, contracts and certificates issued,
renewed, modified, altered or amended on or after such effective date.