New Jersey Senate Bill S2643

New Jersey 2024-2025 Regular Session

• Introduced: 2/8/24
• Refer: 2/8/24

Caption

Requires private health insurers, SHBP, SEHBP, Medicaid, and NJ FamilyCare to cover wigs under certain circumstances.

Impact

The bill intends to standardize wig coverage across multiple health insurance platforms, significantly improving access for individuals who suffer medical hair loss. It allows reimbursement for wig expenses under the same regulations that apply to other forms of durable medical equipment. This is a considerable expansion from current coverage options, particularly for those not undergoing chemotherapy, thus making it more inclusive for individuals with conditions like alopecia or other forms of hair loss due to chronic medical issues.

Summary

Senate Bill S2643 mandates that health insurance providers in New Jersey, including private insurers, the State Health Benefits Program (SHBP), the School Employees Health Benefits Program (SEHBP), Medicaid, and NJ FamilyCare, cover wigs as durable medical equipment for individuals experiencing medical hair loss due to various health conditions, chronic illnesses, or injuries. This coverage is to be provided under certain stipulations, namely, that a licensed physician prescribes the wig and certifies its medical necessity as part of a rehabilitative treatment plan.

Contention

Notably, the bill emphasizes that insurance coverage for wigs cannot be restricted solely to patients undergoing chemotherapy for cancer diagnoses, broadening the scope to include anyone affected by hair loss due to a medical condition. This provision may lead to discussions among insurers regarding cost implications and coverage definitions, as historically, wig coverage has often been limited or contingent on specific medical diagnoses. There is potential for both support and opposition, particularly from different stakeholder groups (patients, insurers, and healthcare providers) depending on how the coverage is interpreted and implemented.