An Act concerning coverage for hair headpieces for patients receiving chemotherapy treatment for cancer and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Every 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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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 hospital service corporation has reserved the right to change the premium.

2. Every 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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

3. Every 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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

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 a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for expenses for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

8. Every enrollee agreement that provides 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 coverage for a headpiece of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage for a headpiece shall be subject to a written recommendation by the treating physician stating that the headpiece 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.

9. This act shall take effect 60 days after the date of enactment.

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 headpieces of human or artificial hair worn to conceal scalp hair loss resulting from chemotherapy treatment for cancer. The coverage shall be subject to a written recommendation by the treating physician stating that the headpiece is medically necessary. Also, the coverage shall be subject to the same limitations and guidelines as for other prostheses under the health benefits plan.

The provisions of the bill will take effect 60 days after the date of enactment and will apply to all health benefits plans issued or renewed on or after that date.