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.

Statutes affected:
S4961: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law