PRIOR PRINTER'S NO. 1096 PRINTER'S NO. 3506
No. 955 Session of 2001
INTRODUCED BY DeLUCA, BEBKO-JONES, BELARDI, BELFANTI,
CAPPABIANCA, L. I. COHEN, COLAFELLA, GEIST, GRUCELA, HARHAI,
JAMES, LAUGHLIN, MELIO, MYERS, ORIE, PALLONE, PRESTON,
SCRIMENTI, SHANER, STABACK, TRAVAGLIO, WALKO, WASHINGTON,
WATERS, J. WILLIAMS, WOJNAROSKI, YOUNGBLOOD, TRELLO, THOMAS,
ZUG, FLEAGLE, FAIRCHILD, WATSON, HARPER, HANNA, HORSEY AND
CREIGHTON, MARCH 14, 2001
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, MARCH 26, 2002
AN ACT
1 Providing for certain health insurance policies to cover the <--
2 cost of scalp hair prostheses.
1 AMENDING THE ACT OF MAY 17, 1921 (P.L.682, NO.284), ENTITLED "AN <--
2 ACT RELATING TO INSURANCE; AMENDING, REVISING, AND
3 CONSOLIDATING THE LAW PROVIDING FOR THE INCORPORATION OF
4 INSURANCE COMPANIES, AND THE REGULATION, SUPERVISION, AND
5 PROTECTION OF HOME AND FOREIGN INSURANCE COMPANIES, LLOYDS
6 ASSOCIATIONS, RECIPROCAL AND INTER-INSURANCE EXCHANGES, AND
7 FIRE INSURANCE RATING BUREAUS, AND THE REGULATION AND
8 SUPERVISION OF INSURANCE CARRIED BY SUCH COMPANIES,
9 ASSOCIATIONS, AND EXCHANGES, INCLUDING INSURANCE CARRIED BY
10 THE STATE WORKMEN'S INSURANCE FUND; PROVIDING PENALTIES; AND
11 REPEALING EXISTING LAWS," PROVIDING CRANIAL HAIR VACUUM
12 PROSTHESES COVERAGE STANDARDS FOR HEALTH INSURANCE POLICIES.
13 The General Assembly of the Commonwealth of Pennsylvania
14 hereby enacts as follows:
15 Section 1. Short title. <--
16 This act shall be known and may be cited as the Scalp Hair
17 Prostheses Insurance Coverage Act.
18 Section 2. Declaration of policy.
19 The General Assembly finds and declares as follows:
1 (1) Scalp hair prostheses are often prescribed for
2 cancer patients who sustain hair loss associated with
3 chemotherapy or persons afflicted with alopecia areata, a
4 genetic disorder affecting the autoimmune system.
5 (2) Scalp hair prostheses minimize the emotional
6 devastation of hair loss, assist in body temperature
7 regulation and protect diseased sensitive skin from
8 ultraviolet radiation.
9 Section 3. Definitions.
10 The following words and phrases when used in this act shall
11 have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Alopecia areata." A microscopically inflammatory, patchy
14 loss of hair occurring in sharply defined areas and involving
15 the scalp.
16 "Health insurance policy." Any individual or group health,
17 sickness and accident insurance policy, group health insurance
18 plans/policies, and all other forms of managed/capitated care
19 plans/policies or subscriber contract or certificate issued by
20 any entity subject to 40 Pa.C.S. Ch. 61 (relating to hospital
21 plan corporations) or 63 (relating to professional health
22 services plan corporations) or the act of May 17, 1921 (P.L.682,
23 No.284), known as The Insurance Company Law of 1921, the act of
24 December 29, 1972 (P.L.1701, No.364), known as the Health
25 Maintenance Organization Act, or the act of December 14, 1992
26 (P.L.835, No.134), known as the Fraternal Benefit Societies
27 Code, or providing hospital or medical/surgical coverage.
28 "Insurer." Any entity that issues a health insurance policy.
29 Section 4. Scalp hair prostheses insurance coverage.
30 A health insurance policy which is delivered, issued for
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1 delivery, renewed, extended or modified in this Commonwealth by
2 an insurer shall provide that the health insurance benefits
3 applicable under the policy include coverage for the cost of
4 scalp hair prostheses for persons who sustain hair loss as a
5 result of cancer chemotherapy or alopecia areata.
6 Section 5. Delivery of policy.
7 If a health insurance policy provides coverage or benefits to
8 a resident of this Commonwealth, it shall be deemed to be
9 delivered in this Commonwealth within the meaning of this act,
10 regardless of whether the health care insurer issuing or
11 delivering the policy is located within or outside this
12 Commonwealth.
13 Section 6. Cost-sharing provisions.
14 Benefits for scalp hair prostheses shall be subject to any
15 annual deductible, copayment and coinsurance provisions of a
16 health insurance policy to the extent that other medical
17 services covered by the policy are subject to those provisions.
18 Section 7. Applicability.
19 This act shall apply to health insurance policies issued
20 under any group master policy delivered or issued for delivery
21 on or after the effective date of this act. This act shall also
22 apply to all renewals of contracts on any renewal date which is
23 on or after the effective date of this act.
24 Section 8. Effective date.
25 This act shall take effect in 60 days.
26 SECTION 1. THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN <--
27 AS THE INSURANCE COMPANY LAW OF 1921, IS AMENDED BY ADDING A
28 SECTION TO READ:
29 SECTION 635.2. CRANIAL HAIR VACUUM PROSTHESES INSURANCE
30 COVERAGE.--(A) A HEALTH INSURANCE POLICY SHALL PROVIDE THAT THE
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1 HEALTH INSURANCE BENEFITS APPLICABLE UNDER THE POLICY INCLUDE
2 COVERAGE FOR THE COST OF A MEDICALLY NECESSARY CRANIAL HAIR
3 VACUUM PROSTHESIS WHEN PRESCRIBED BY A PHYSICIAN FOR A PERSON
4 WHO SUSTAINS HAIR LOSS AS A RESULT OF ALOPECIA TOTALIS OR
5 ALOPECIA UNIVERSALIS.
6 (B) IF A HEALTH INSURANCE POLICY PROVIDES COVERAGE OR
7 BENEFITS TO A RESIDENT OF THIS COMMONWEALTH, IT SHALL BE DEEMED
8 TO BE DELIVERED IN THIS COMMONWEALTH WITHIN THE MEANING OF THIS
9 SECTION, REGARDLESS OF WHETHER THE INSURER ISSUING OR DELIVERING
10 THE POLICY IS LOCATED WITHIN OR OUTSIDE THIS COMMONWEALTH.
11 (C) BENEFITS FOR CRANIAL HAIR VACUUM PROSTHESES SHALL BE
12 SUBJECT TO ANY ANNUAL DEDUCTIBLE, COPAYMENT AND COINSURANCE
13 PROVISIONS OF A HEALTH INSURANCE POLICY TO THE EXTENT THAT OTHER
14 MEDICAL SERVICES COVERED BY THE POLICY ARE SUBJECT TO THOSE
15 PROVISIONS. A BENEFIT LIMIT OF ONE THOUSAND FIVE HUNDRED DOLLARS
16 ONCE EVERY THREE (3) YEARS SHALL APPLY TO CRANIAL HAIR VACUUM
17 PROSTHESES COVERED UNDER THIS SECTION.
18 (D) THIS SECTION SHALL APPLY TO ANY HEALTH INSURANCE POLICY
19 OFFERED, ISSUED OR RENEWED ON OR AFTER THE EFFECTIVE DATE OF
20 THIS SECTION IN THIS COMMONWEALTH: PROVIDED, THAT THIS SECTION
21 SHALL NOT INCLUDE THE FOLLOWING POLICIES: ACCIDENT ONLY, FIXED
22 INDEMNITY, LIMITED BENEFIT, CREDIT, DENTAL, VISION, SPECIFIED
23 DISEASE, MEDICARE SUPPLEMENT, CHAMPUS (CIVILIAN HEALTH AND
24 MEDICAL PROGRAM FOR THE UNIFORMED SERVICES) SUPPLEMENT, LONG-
25 TERM CARE, DISABILITY INCOME, WORKERS' COMPENSATION OR
26 AUTOMOBILE MEDICAL PAYMENT.
27 (E) AS USED IN THIS SECTION:
28 (1) "ALOPECIA TOTALIS" MEANS AN AUTOIMMUNE DISEASE RESULTING
29 IN COMPLETE SCALP HAIR LOSS.
30 (2) "ALOPECIA UNIVERSALIS" MEANS AN AUTOIMMUNE DISEASE
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1 RESULTING IN COMPLETE BODY HAIR LOSS.
2 (3) "CRANIAL HAIR VACUUM PROSTHESIS" MEANS A CUSTOM DESIGNED
3 SYSTEM UTILIZING SPECIALIZED MATERIALS TO REPLACE HAIR LOSS DUE
4 TO ALOPECIA TOTALIS OR ALOPECIA UNIVERSALIS.
5 (4) "HEALTH INSURANCE POLICY" MEANS ANY GROUP HEALTH,
6 SICKNESS OR ACCIDENT POLICY OR SUBSCRIBER CONTRACT OR
7 CERTIFICATE ISSUED BY AN ENTITY SUBJECT TO ONE (1) OF THE
8 FOLLOWING:
9 (I) THIS ACT.
10 (II) THE ACT OF DECEMBER 29, 1972 (P.L.1701, NO.364), KNOWN
11 AS THE "HEALTH MAINTENANCE ORGANIZATION ACT."
12 (III) 40 PA.C.S. CH. 61 (RELATING TO HOSPITAL PLAN
13 CORPORATIONS) OR 63 (RELATING TO PROFESSIONAL HEALTH SERVICES
14 PLAN CORPORATIONS).
15 (5) "INSURER" MEANS AN ENTITY THAT ISSUES A HEALTH INSURANCE
16 POLICY.
17 SECTION 2. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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