SENATE, No. 2045
STATE OF NEW JERSEY
INTRODUCED MAY 8, 1997
By Senator INVERSO
An Act concerning coverage for scalp hair prostheses and supplementing P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), Chapters 26 and 27 of Title 17B of the New Jersey Statutes, P.L.1992, c.161 (C.17B:27A-2 et seq.), P.L.1992, c.162 (C.17B:27A-17 et seq.) and P.L.1973, c.337 (C.26:2J-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Every individual or group hospital service corporation contract that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act shall provide coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other protheses under the contract.
The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
2. Every individual or group medical service corporation contract that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the contract.
The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
3. Every individual or group health service corporation contract that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the contract.
The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
4. Every individual policy that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq. or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
5. Every group policy that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq. or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the policy.
The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
6. Every individual health benefits plan that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
7. Every small employer health benefits plan that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State on or after the effective date of this act shall provide benefits for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
8. Every enrollee agreement that provides hospital or medical expense benefits which includes coverage for prostheses and is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Health and Senior Services on or after the effective date of this act, shall provide health care services for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The services shall be subject to a written recommendation by the treating physician stating that the scalp hair prosthesis is medically necessary.
The coverage shall be subject to the same limitations and guidelines as other prostheses under the enrollee agreement.
The provisions of this section shall apply to enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
For the purposes of this section, "scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for an individual.
9. This act shall take effect immediately.
STATEMENT
This bill requires hospital, medical and health service corporations, individual and small and large group commercial health insurers and health maintenance organizations which provide coverage for prostheses, to provide coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis or permanent loss of scalp hair due to injury. The coverage shall be subject to a written recommendation by the treating physician stating that the hair prosthesis is medically necessary. The bill defines "scalp hair prostheses" as artificial substitutes for scalp hair that are made specifically for an individual. Alopecia is the absence of hair from areas where hair normally grows, and alopecia areata is a condition of unknown origin in which hair falls out in patches.
Requires health insurance coverage for scalp hair prostheses.