S 4961: Provides insurance coverage for cranial prostheses for a diagnosed health condition, chronic illness, or injury.

  
  STATE OF NEW YORK ________________________________________________________________________ 4961 2025-2026 Regular Sessions  IN SENATE 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: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 40 to read as follows: 3 (40) (A) Every policy which provides coverage for prostheses shall 4 provide coverage for cranial prostheses for individuals experiencing 5 permanent or temporary medical hair loss provided: 6 (i) a licensed provider prescribes such cranial prosthesis for a 7 covered person's course of treatment for the diagnosed health condition, 8 chronic illness, or injury, including, but not limited to, alopecia 9 areata, alopecia medicamentosa, scarring alopecia, and lupus; 10 (ii) the policy provides coverage for a cranial prosthesis to a 11 covered person no more frequently than once every twelve months; and 12 (iii) the coverage is limited to seven hundred fifty dollars for each 13 instance of coverage, and shall be subject to any cost-sharing require- 14 ments that are otherwise applicable. 15 (B) For purposes of this paragraph, the term "cranial prosthesis" 16 means a wig or hairpiece. 17 § 2. Subsection (l) of section 3221 of the insurance law is amended by 18 adding a new paragraph 23 to read as follows: 19 (23) (A) Every group or blanket policy delivered or issued for deliv- 20 ery in this state that provides coverage for protheses shall provide 21 coverage for cranial prostheses for individuals experiencing permanent 22 or temporary medical hair loss provided: 23 (i) a licensed provider prescribes the cranial prosthesis for an 24 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 1 chronic illness, or injury, including, but not limited to, alopecia 2 areata, alopecia medicamentosa, scarring alopecia, and lupus; 3 (ii) the policy provides coverage for a cranial prosthesis to an indi- 4 vidual enrollee no more frequently than once every twelve months; and 5 (iii) the coverage is limited to seven hundred fifty dollars for each 6 instance of coverage, and shall be subject to any cost-sharing require- 7 ments that are otherwise applicable. 8 (B) For purposes of this paragraph, the term "cranial prosthesis" 9 means a wig or hairpiece. 10 § 3. Section 4303 of the insurance law is amended by adding a new 11 subsection (ww) to read as follows: 12 (ww) (1) A hospital service corporation, health service corporation or 13 medical expense indemnity fund which provides coverage for prostheses 14 shall provide coverage for cranial prostheses for individuals experienc- 15 ing permanent or temporary medical hair loss provided: 16 (A) a licensed provider prescribes the cranial prosthesis for an 17 enrollee's or subscriber's course of treatment for the diagnosed health 18 condition, chronic illness, or injury, including, but not limited to, 19 alopecia areata, alopecia medicamentosa, scarring alopecia, and lupus; 20 (B) the contract provides coverage for a cranial prosthesis to an 21 individual enrollee or subscriber no more frequently than once every 22 twelve months; and 23 (C) the coverage is limited to seven hundred fifty dollars for each 24 instance of coverage, and shall be subject to any cost-sharing require- 25 ments that are otherwise applicable. 26 (2) For the purposes of this subsection, the term "cranial prosthesis" 27 means a wig or hairpiece. 28 § 4. This act shall take effect immediately and shall apply to any 29 policy issued, delivered, renewed, and/or modified on or after such 30 effective date of this act.