ARTIFICIAL LIMBS; CANCER; HEALTH INSURANCE; MEDICAL CARE;

DISEASES;

You asked whether other states require insurance companies to provide coverage for wigs for people who lose their hair because of chemotherapy.

SUMMARY

According to Richard Cauchi, an insurance expert with the National Conference of State Legislatures (NCSL), five states require insurers to provide coverage for wigs under certain circumstances-Maryland (2000), Massachusetts (1998), Minnesota (1987), New Hampshire (1992), and Oklahoma (2000). Oklahoma limits the mandatory coverage to $ 150 a year. Maryland sets its limit at $ 350. The other three states set an annual limit of $ 350.

Three of the states limit the mandatory coverage to hair loss caused by chemotherapy or radiation (Maryland, Minnesota, and Oklahoma). New Hampshire also covers permanent hair loss caused by an injury. Minnesota appears to limit its mandatory coverage to hair loss caused by an autoimmune disease called alopecia areata. New Hampshire also appears to cover hair loss caused by this autoimmune disease.

Oklahoma’s law does not apply to individual health insurance plans, group plans involving 50 or fewer people, or plans under the state’s Medicaid program.

MARYLAND

Maryland requires insurers to provide one hair prosthesis up to a $ 350 limit for an enrollee or insured whose hair loss results from chemotherapy or radiation treatment for cancer. The wig must be prescribed by the oncologist in attendance (Md. Code Ann, § 15-836).

MASSACHUSETTS

Under Massachusetts law, any blanket or general insurance policy, any accident and sickness insurance policy, or any employees’ health and welfare fund that provides hospital and surgical benefits, must provide up to $ 350 of annual coverage for scalp hair prosthesis worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia if such policy or fund provides coverage for any other prosthesis. But the physician must state in writing that the scalp hair prosthesis is medically necessary. Such coverage is also subject to the same limitations and guidelines as other prostheses. (Mass. Gen. Laws ch. 32A,17E; ch. 175,§ 47T; ch. 176A § 8T; ch. 176B § 4R; ch. 176G § 4J).

MINNESOTA

Minnesota requires that every health care insurance plan, policy, contract, or certificate must provide coverage for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata. The coverage is subject to a policy’s co-payment requirement and is limited to a maximum of $ 350 in any benefit year, exclusive of any deductible (Minn. Stat. § 62 A. 28).

Alopecia areata is a common autoimmune disease that results in the loss of hair on the scalp and elsewhere. It occurs in males and females of all ages and races, but onset most often occurs in childhood. According to The National Alopecia Areata Foundation, approximately 2% of the population will be affected at some point in their lives. We have enclosed additional information about this disease.

NEW HAMPSHIRE

New Hampshire requires insurers to cover scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis (total loss of hair from all parts of the body), alopecia medicamentosa (a diffuse hair loss most notably on the scalp caused by the administration of various types of drugs) resulting from treatment for cancer or leukemia, or permanent loss of scalp hair due to injury. The coverage requires a written recommendation by the treating physician stating that the hair prosthesis is a medical necessity. The coverage is subject to the same limitations and guidelines as other prosthesis and is limited to $ 350 a year (N. H. Rev. Stat. Ann. Laws § 415: 18-d; 420-A: 14; and 420-B: 8-f).

OKLAHOMA

Under Oklahoma law, any health benefit plan that provides medical and surgical benefits for the treatment of cancer and other conditions treated by chemotherapy or radiation therapy must provide coverage for wigs or other scalp prostheses necessary for the comfort and dignity of the covered person. The coverage is subject to the same annual deductibles, co-payments, or coinsurance limits as all other covered benefits under the health benefit plan up to $ 150. 00 annually.

This requirement does not apply to policies or certificates issued to individuals or groups with 50 or fewer employees or plans offered under the state Medicaid Program.

The law requires a health benefit plan to notify each policy holder of this coverage.

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