S T A T E   O F   N E W   Y O R K
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                                  1596

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  M. of A. CAHILL, ENGLEBRIGHT -- Multi-Sponsored by -- M.
  of A. BRENNAN, 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 ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 30 to read as follows:
  (30)  (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 19 to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03759-01-3
              

A. 1596                             2

  (19) (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 (jj) to read as follows:
  (JJ)  (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.