Topic:
HEALTH INSURANCE;
Location:
INSURANCE - HEALTH - MANDATES;

OLR Research Report


September 3, 2004

 

2004-R-0715

INSURANCE COVERAGE FOR WIGS

By: Janet L. Kaminski, Associate Legislative Attorney

You asked if other states require insurance companies to provide coverage for wigs for patients who suffer hair loss from chemotherapy. You also asked if these states require coverage for wigs for patients with hair loss from other diseases and treatments.

SUMMARY

Five other states require insurance companies to provide coverage for wigs under certain conditions: Maryland, Massachusetts, Minnesota, New Hampshire, and Oklahoma. Maryland requires wig coverage for hair loss from chemotherapy or radiation cancer treatment. Massachusetts requires it for hair loss from cancer or leukemia treatment. Oklahoma requires it for hair loss from chemotherapy or radiation treatment for cancer or other conditions (not specified). Minnesota requires wig coverage for hair loss caused by alopecia areata, an autoimmune disease. New Hampshire requires it for hair loss caused by (1) various forms of alopecia and (2) injury.

COVERAGE

Connecticut requires insurance companies to provide coverage for a wig worn for hair loss caused by chemotherapy, beginning October 1, 2004. Wig coverage mandates are detailed in Table 1.

TABLE 1 – MANDATED WIG COVERAGE

State

Effective

Description

Amount

Connecticut

10/1/2004

Coverage for a wig worn for hair loss caused by chemotherapy treatment, if prescribed by a licensed oncologist.

A yearly benefit of at least $350.

Maryland

10/1/2000

Coverage for one hair prosthesis worn for hair loss caused by chemotherapy or radiation treatment for cancer.

The cost of the hair prosthesis may not exceed $350.

Massachusetts

8/27/1998

Coverage for scalp hair prostheses worn for hair loss caused by the treatment of any form of cancer or leukemia, if the policy provides coverage for any other prostheses, provided the treating physician states in writing that hair prostheses are medically necessary.

Coverage is subject to (1) the same limitations and guidelines as other prostheses and (2) a $350 per year maximum.

Minnesota

8/1/1987

Coverage for scalp hair prostheses worn for hair loss caused by alopecia areata.

Coverage is subject to (1) cost-sharing requirements that apply to similar items under the policy and (2) a $350 per benefit year maximum.

New Hampshire

1/1/1993

Coverage for scalp hair prostheses worn for hair loss caused by alopecia areata, alopecia totalis, or alopecia medicamentosa resulting from the treatment of any form of cancer or leukemia, or permanent scalp hair loss due to injury, if the policy provides coverage for any other prostheses, provided the treating physician states in writing that hair prostheses are medically necessary.

Coverage is subject to the same limitations and guidelines as other prostheses except coverage for alopecia medicamentosa, which is subject to a $350 per year maximum.

Oklahoma

1/1/2001

Coverage for wigs or other scalp prostheses worn for hair loss caused by chemotherapy or radiation treatment for cancer and other conditions.

Coverage is subject to the same annual deductibles, copayments, or coinsurance limits as all other covered benefits, up to $150 per year.

CITATIONS

Connecticut: PA 04-34; Conn. Gen. Stat 38a-504 and 542

Maryland: Md. Code Ann. 15-836

Massachusetts: Mass. Gen. Laws ch. 175, 47T; ch. 176A, 8T; ch. 176B, 4R; and ch. 176G, 4J

Minnesota: Minn. Stat. 62A.28

New Hampshire: N.H. Rev. Stat. Ann. 415:18-d, 420-A:14, and 420-B:8-f

Oklahoma: Okla. Stat. tit. 36, 6060.9

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