NY State Bill 2025-S4961

Current Bill Status - In Senate Committee Finance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 28, 2025	reported and committed to finance
Feb 14, 2025	referred to insurance

Votes

- May 28, 2025 - Insurance Committee Vote
  S4961
  
  8
  
  Aye
  
  0
  
  Nay
  
  3
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: May 28, 2025
      
      aye (8)
      
      Addabbo Jr.
      
      Bailey
      
      Cooney
      
      Fernandez
      
      Gounardes
      
      Harckham
      
      Sanders Jr.
      
      Skoufis
      
      aye wr (3)
      
      Ashby
      
      Helming
      
      O'Mara

2025-S4961 (ACTIVE) - Details

Current Committee:: Senate Finance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S9642

2025-S4961 (ACTIVE) - Summary

Provides insurance coverage for cranial prostheses for a diagnosed health condition, chronic illness, or injury.

2025-S4961 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S4961

SPONSOR: BAILEY
 
TITLE OF BILL:

An act to amend the insurance law, in relation to providing insurance
coverage for cranial prostheses

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to expand certain insurance policies that
provide coverage for prosthetics to include a minimum coverage for
cranial prostheses.

 
SUMMARY OF PROVISIONS:

Section 1 of the bill requires that every policy for individual accident
and health insurance that provides coverage for prostheses also provide
coverage for cranial prostheses for individuals experiencing permanent
or temporary hair loss.

Section 2 requires that every policy group or blanket accident and

health insurance that provides coverage for prostheses also provide
coverage for cranial prostheses for individuals experiencing permanent
or temporary hair loss.

Section 3 requires that every policy for a hospital service corporation
or health service corporation that provides coverage for prostheses also
provide coverage for cranial prostheses for individuals experiencing
permanent or temporary hair loss.

 
JUSTIFICATION:

It is common for health insurers in the state to provide coverage for
prosthetics and other durable medical equipment; however, few insurers,
if any, also cover cranial prostheses, such as wigs and hairpieces. For
patients with conditions such as alopecia or lupus that result in hair
loss, cranial prostheses may be prescribed as part of their treatment.
Furthermore, a high-quality prosthesis can cost hundreds of dollars,
presenting a hardship to many of these patients.

Insurance carriers don't cover cranial prostheses under the pretext that
alopecia or other medical hair loss is a cosmetic condition. But these
are serious diseases that have a significant impact on patients' quality
of life. Access to cranial prostheses, just like other prostheses and
durable medical equipment, can have a positive effect on patient
outcomes, which is why providers may include these as part of a treat-
ment plan. The purpose of this bill is to expand certain insurance poli-
cies that provide coverage for prosthetics to include a minimum coverage
for cranial prostheses.

 
LEGISLATIVE HISTORY:

2023-24: S9642 - Referred to Insurance

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately and shall apply to any policy
issued, delivered, renewed, and/or modified on or after the effective
date of this act.

2025-S4961 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4961
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 14, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation  to  providing  insurance
   coverage for cranial prostheses
 
   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 40 to read as follows:
   (40)  (A)  EVERY  POLICY  WHICH PROVIDES COVERAGE FOR PROSTHESES SHALL
 PROVIDE COVERAGE FOR CRANIAL  PROSTHESES  FOR  INDIVIDUALS  EXPERIENCING
 PERMANENT OR TEMPORARY MEDICAL HAIR LOSS PROVIDED:
   (I)  A  LICENSED  PROVIDER  PRESCRIBES  SUCH  CRANIAL PROSTHESIS FOR A
 COVERED PERSON'S COURSE OF TREATMENT FOR THE DIAGNOSED HEALTH CONDITION,
 CHRONIC ILLNESS, OR INJURY, INCLUDING,  BUT  NOT  LIMITED  TO,  ALOPECIA
 AREATA, ALOPECIA MEDICAMENTOSA, SCARRING ALOPECIA, AND LUPUS;
   (II)  THE  POLICY  PROVIDES  COVERAGE  FOR  A  CRANIAL PROSTHESIS TO A
 COVERED PERSON NO MORE FREQUENTLY THAN ONCE EVERY TWELVE MONTHS; AND
   (III) THE COVERAGE IS LIMITED TO SEVEN HUNDRED FIFTY DOLLARS FOR  EACH
 INSTANCE  OF COVERAGE, AND SHALL BE SUBJECT TO ANY COST-SHARING REQUIRE-
 MENTS THAT ARE OTHERWISE APPLICABLE.
   (B) FOR PURPOSES OF THIS  PARAGRAPH,  THE  TERM  "CRANIAL  PROSTHESIS"
 MEANS A WIG OR HAIRPIECE.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23)  (A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
 ERY IN THIS STATE THAT PROVIDES COVERAGE  FOR  PROTHESES  SHALL  PROVIDE
 COVERAGE  FOR  CRANIAL PROSTHESES FOR INDIVIDUALS EXPERIENCING PERMANENT
 OR TEMPORARY MEDICAL HAIR LOSS PROVIDED:
   (I) A LICENSED PROVIDER  PRESCRIBES  THE  CRANIAL  PROSTHESIS  FOR  AN
 ENROLLEE'S  COURSE  OF  TREATMENT  FOR  THE  DIAGNOSED HEALTH CONDITION,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07940-01-5
 S. 4961                             2

 
 CHRONIC ILLNESS, OR INJURY, INCLUDING,  BUT  NOT  LIMITED  TO,  ALOPECIA
 AREATA, ALOPECIA MEDICAMENTOSA, SCARRING ALOPECIA, AND LUPUS;
   (II) THE POLICY PROVIDES COVERAGE FOR A CRANIAL PROSTHESIS TO AN INDI-
 VIDUAL ENROLLEE NO MORE FREQUENTLY THAN ONCE EVERY TWELVE MONTHS; AND
   (III)  THE COVERAGE IS LIMITED TO SEVEN HUNDRED FIFTY DOLLARS FOR EACH
 INSTANCE OF COVERAGE, AND SHALL BE SUBJECT TO ANY COST-SHARING  REQUIRE-
 MENTS THAT ARE OTHERWISE APPLICABLE.
   (B)  FOR  PURPOSES  OF  THIS  PARAGRAPH, THE TERM "CRANIAL PROSTHESIS"
 MEANS A WIG OR HAIRPIECE.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW) (1) A HOSPITAL SERVICE CORPORATION, HEALTH SERVICE CORPORATION OR
 MEDICAL  EXPENSE  INDEMNITY  FUND WHICH PROVIDES COVERAGE FOR PROSTHESES
 SHALL PROVIDE COVERAGE FOR CRANIAL PROSTHESES FOR INDIVIDUALS EXPERIENC-
 ING PERMANENT OR TEMPORARY MEDICAL HAIR LOSS PROVIDED:
   (A) A LICENSED PROVIDER  PRESCRIBES  THE  CRANIAL  PROSTHESIS  FOR  AN
 ENROLLEE'S  OR SUBSCRIBER'S COURSE OF TREATMENT FOR THE DIAGNOSED HEALTH
 CONDITION, CHRONIC ILLNESS, OR INJURY, INCLUDING, BUT  NOT  LIMITED  TO,
 ALOPECIA AREATA, ALOPECIA MEDICAMENTOSA, SCARRING ALOPECIA, AND LUPUS;
   (B)  THE  CONTRACT  PROVIDES  COVERAGE  FOR A CRANIAL PROSTHESIS TO AN
 INDIVIDUAL ENROLLEE OR SUBSCRIBER NO MORE  FREQUENTLY  THAN  ONCE  EVERY
 TWELVE MONTHS; AND
   (C)  THE  COVERAGE  IS LIMITED TO SEVEN HUNDRED FIFTY DOLLARS FOR EACH
 INSTANCE OF COVERAGE, AND SHALL BE SUBJECT TO ANY COST-SHARING  REQUIRE-
 MENTS THAT ARE OTHERWISE APPLICABLE.
   (2) FOR THE PURPOSES OF THIS SUBSECTION, THE TERM "CRANIAL PROSTHESIS"
 MEANS A WIG OR HAIRPIECE.
   §  4.  This  act  shall take effect immediately and shall apply to any
 policy issued, delivered, renewed, and/or  modified  on  or  after  such
 effective date of this act.

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Senate Bill S4961

Sponsored By

Current Bill Status - In Senate Committee Finance Committee

May 28, 2025 - Insurance Committee Vote

Insurance Committee Vote: May 28, 2025

2025-S4961 (ACTIVE) - Details

2025-S4961 (ACTIVE) - Summary

2025-S4961 (ACTIVE) - Sponsor Memo

2025-S4961 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S4961

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Sponsored By

Jamaal T. Bailey

Current Bill Status - In Senate Committee Finance Committee

2025-S4961 (ACTIVE) - Details

2025-S4961 (ACTIVE) - Summary

2025-S4961 (ACTIVE) - Sponsor Memo

2025-S4961 (ACTIVE) - Bill Text download pdf

Comments