Bill Text: NY A01211 | 2015-2016 | General Assembly | Introduced

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Bill Title: Requires group health plans and health insurance issuers to cover costs for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or alopecia universalis.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced - Dead) 2016-01-06 - referred to insurance [A01211 Detail]

Download: New_York-2015-A01211-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         1211
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                    January 8, 2015
                                      ___________
       Introduced by M. of A. CAHILL -- Multi-Sponsored by -- M. of A. BRENNAN,
         ENGLEBRIGHT,  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:
    1    Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
    2  amended by adding a new paragraph 32 to read as follows:
    3    (32)  (A)  A GROUP HEALTH PLAN, AND A HEALTH INSURANCE ISSUER OFFERING
    4  HEALTH INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN,  SHALL
    5  PROVIDE  COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR BENEFI-
    6  CIARY WHO HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA  AREATA,  ALOPECIA
    7  TOTALIS  OR  ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN OF THE
    8  PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
    9  THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   10    (B) AS USED IN  THIS  PARAGRAPH,  THE  TERM  "SCALP  HAIR  PROSTHESIS"
   11  INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
   12    (C)  THE  COVERAGE  REQUIRED  UNDER  THIS  PARAGRAPH IS NOT SUBJECT TO
   13  DOLLAR LIMITS, DEDUCTIBLES, AND COINSURANCE  PROVISIONS  THAT  ARE  LESS
   14  FAVORABLE  THAN  THOSE  FOR  OTHER PROSTHESIS COVERAGE UNDER THE PLAN OR
   15  COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
   16  PROVIDE THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF  THE
   17  CUSTOMARY  AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF ANY
   18  DEDUCTIBLE.
   19    S 2. Subsection (k) of section 3221 of the insurance law is amended by
   20  adding a new paragraph 20 to read as follows:
   21    (20) (A) A GROUP HEALTH PLAN, AND A HEALTH INSURANCE  ISSUER  OFFERING
   22  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.
                                                                  LBD06243-02-5
       A. 1211                             2
    1  PROVIDE COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR  BENEFI-
    2  CIARY  WHO  HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA, ALOPECIA
    3  TOTALIS OR ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN  OF  THE
    4  PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
    5  THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
    6    (B)  AS  USED  IN  THIS  PARAGRAPH,  THE  TERM "SCALP HAIR PROSTHESIS"
    7  INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
    8    (C) THE COVERAGE REQUIRED UNDER  THIS  PARAGRAPH  IS  NOT  SUBJECT  TO
    9  DOLLAR  LIMITS,  DEDUCTIBLES,  AND  COINSURANCE PROVISIONS THAT ARE LESS
   10  FAVORABLE THAN THOSE FOR OTHER PROSTHESIS COVERAGE  UNDER  THE  PLAN  OR
   11  COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
   12  PROVIDE  THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF THE
   13  CUSTOMARY AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF  ANY
   14  DEDUCTIBLE.
   15    S  3.  Section  4303  of  the insurance law is amended by adding a new
   16  subsection (pp) to read as follows:
   17    (PP) (1) A GROUP HEALTH PLAN, AND A HEALTH INSURANCE  ISSUER  OFFERING
   18  HEALTH  INSURANCE COVERAGE IN CONNECTION WITH A GROUP HEALTH PLAN, SHALL
   19  PROVIDE COVERAGE FOR SCALP HAIR PROSTHESIS FOR A PARTICIPANT OR  BENEFI-
   20  CIARY  WHO  HAS SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA, ALOPECIA
   21  TOTALIS OR ALOPECIA  UNIVERSALIS  IF  THE  ATTENDING  PHYSICIAN  OF  THE
   22  PARTICIPANT OR BENEFICIARY CERTIFIES IN WRITING THE MEDICAL NECESSITY OF
   23  THAT PROPOSED COURSE OF REHABILITATIVE TREATMENT.
   24    (2)  AS  USED  IN  THIS  SUBSECTION,  THE TERM "SCALP HAIR PROSTHESIS"
   25  INCLUDES ANY ARTIFICIAL SUBSTITUTES FOR SCALP HAIR.
   26    (3) THE COVERAGE REQUIRED UNDER THIS  SUBSECTION  IS  NOT  SUBJECT  TO
   27  DOLLAR  LIMITS,  DEDUCTIBLES,  AND  COINSURANCE PROVISIONS THAT ARE LESS
   28  FAVORABLE THAN THOSE FOR OTHER PROSTHESIS COVERAGE  UNDER  THE  PLAN  OR
   29  COVERAGE, EXCEPT THAT A GROUP HEALTH PLAN OR HEALTH INSURANCE ISSUER MAY
   30  PROVIDE  THAT THE PLAN OR ISSUER WILL ONLY PAY FOR EIGHTY PERCENT OF THE
   31  CUSTOMARY AND USUAL COSTS OF THE SCALP HAIR PROSTHESIS EXCLUSIVE OF  ANY
   32  DEDUCTIBLE.
   33    S  4. This act shall take effect on the first of January next succeed-
   34  ing the date on which it shall have become a law and shall apply accord-
   35  ing to its terms to all policies,  contracts  and  certificates  issued,
   36  renewed, modified, altered or amended on or after such effective date.