Bill Text: NY A01596 | 2013-2014 | 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) 2014-01-08 - referred to insurance [A01596 Detail]

Download: New_York-2013-A01596-Introduced.html

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