OLR Bill Analysis
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR WIGS FOR INDIVIDUALS WITH HAIR LOSS DUE TO A DIAGNOSED MEDICAL CONDITION.
This bill expands current law regarding health insurance coverage for wigs. By law, certain health insurance policies must provide coverage for an oncologist-prescribed wig for a person with hair loss resulting from chemotherapy. The coverage must be subject to the same terms and conditions applicable to all other policy benefits, but be at least a yearly benefit of $ 350. The bill requires that the coverage also include a licensed physician- or advanced practice registered nurse-prescribed wig for a person with hair loss caused by a diagnosed medical condition, except androgenetic alopecia (e. g. , male-pattern baldness).
The bill applies certain insurance coverage requirements (i. e. , treatment of tumors and leukemia, reconstructive surgery, nondental prosthesis, chemotherapy, and wigs for chemotherapy patients) to policies renewed, amended, or continued in Connecticut. By law, the requirements apply to policies issued or delivered in the state.
The bill also makes technical changes.
EFFECTIVE DATE: January 1, 2010
APPLICABILITY OF WIG COVERAGE REQUIREMENT
The bill's wig coverage requirement applies to each insurer, hospital or medical service corporation, HMO, or fraternal benefit society that delivers, issues, renews, amends, or continues in Connecticut, on and after January 1, 2010, (1) individual or group health insurance policies that cover (a) basic hospital expenses; (b) basic medical-surgical expenses; (c) major medical expenses; and (d) hospital or medical services, including coverage under an HMO plan, and (2) individual health insurance policies that provide limited benefit health coverage.
COVERAGE FOR TREATMENT OF TUMORS AND LEUKEMIA, RECONSTRUCTIVE SURGERY, NONDENTAL PROSTHESIS, CHEMOTHERAPY, AND WIGS
The bill requires certain health insurance policies renewed, amended, or continued in Connecticut to provide coverage for:
1. surgical removal of tumors and outpatient chemotherapy following the surgery;
2. treatment of leukemia, including outpatient chemotherapy;
3. reconstructive surgery, including reconstructive surgery (such as augmentation or reduction mammoplasty and mastopexy) on a breast on which a mastectomy was performed and a nondiseased breast for symmetry;
4. nondental prosthesis, including any maxillo-facial prosthesis used to replace anatomic structures lost during treatment for head and neck tumors or additional appliances essential for the support of such a prosthesis; and
5. an oncologist-prescribed wig for a patient with hair loss resulting from chemotherapy.
Coverage must be subject to the same terms and conditions applicable to other benefits under the policy. But the policy must provide at least a yearly benefit of $ 500 for the surgical removal of tumors, $ 500 for reconstructive surgery, $ 500 for outpatient chemotherapy, $ 350 for a wig, and $ 300 for a nondental prosthesis, unless the prosthesis is due to the surgical removal of breasts because of tumors, in which case the yearly benefit must be at least $ 300 for each breast.
By law, policies issued or delivered in Connecticut must include these benefits.
Applicability
The bill applies the coverage requirements to each insurer, hospital or medical service corporation, HMO, or fraternal benefit society that renews, amends, or continues in Connecticut, on and after January 1, 2010, (1) individual or group health insurance policies that cover (a) basic hospital expenses; (b) basic medical-surgical expenses; (c) major medical expenses; and (d) hospital or medical services, including coverage under an HMO plan, and (2) individual health insurance policies that provide limited benefit health coverage.
BACKGROUND
Self-Insured Benefit Plans
Due to federal law (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.
COMMITTEE ACTION
Insurance and Real Estate Committee
Joint Favorable Substitute
Yea |
14 |
Nay |
5 |
(02/10/2009) |