New Jersey Assembly Bill A4105

New Jersey 2024-2025 Regular Session

• Introduced: 4/4/24
• Refer: 4/4/24

Caption

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

Impact

If enacted, this bill will potentially alter existing policies concerning health insurance coverage for individuals experiencing hair loss. The requirement for coverage at least once every 36 months will standardize the expectations from insurers and provide more equitable access to wigs for various medical conditions, not limiting it solely to cancer patients undergoing chemotherapy. Currently, SHBP and SEHBP cover wigs mostly for chemotherapy patients, but A4105 broadens this to include other medical conditions.

Summary

Assembly Bill A4105 requires private health insurers, State Health Benefits Program (SHBP), School Employees Health Benefits Program (SEHBP), Medicaid, and NJ FamilyCare to provide coverage for wigs under specific circumstances. The bill stipulates that a wig must be prescribed by a state-licensed dermatologist, oncologist, or attending physician, and the provider must certify the medical necessity of the wig as part of treatment for a diagnosed illness, chronic condition, or injury. This legislation aims to ensure that individuals suffering from hair loss due to medical conditions have access to wigs as a part of their healthcare coverage.

Contention

Notable points of contention may arise regarding the definition of medical necessity and the additional financial burden on insurance providers. There may be concerns about the costs associated with the stipulated coverage and whether insurers may push back against the requirement to cover wigs for all qualifying conditions. Moreover, the potential demand for wigs under Medicaid and NJ FamilyCare will depend on obtaining federal approval for waivers to ensure continued funding. Opponents might argue that such measures could increase insurance premiums or limit coverage in other areas to accommodate this new obligation.