Bill > A4964

Introduced Session

This bill requires private health insurance plans, the State Health Benefits Program (SHBP), the School Employees Health Benefits Program (SEHBP), the State Medicaid program, and the NJ FamilyCare program to provide coverage for wigs for subscribers or enrollees on the same basis as other items of durable medical equipment. It is the intent of the bill's sponsor to require all health insurers that operate in the State to provide reimbursement for expenses incurred for the purchase of a wig for individuals experiencing medical hair loss due to health conditions, chronic illnesses, or injury. Pursuant to the bill, all individual, group, or small employer health insurers, the SHBP, the SEHBP, Medicaid and the NJ FamilyCare programs are required to provide coverage for a wig, provided the subscriber or enrollee has been prescribed the wig by a State-licensed dermatologist, oncologist, or attending physician, and the prescribing physician certifies, in writing, the medical necessity of a wig as part of the enrollee's proposed course of treatment for a diagnosed illness, chronic medical condition, or injury. Pursuant to the bill, all health insurers operating in the State are required to cover the purchase of a new wig for a subscriber once every 36 months. The Commissioner of Human Services is required to determine the frequency with which Medicaid and NJ FamilyCare enrollees are eligible for a new wig. The commissioner is additionally directed to determine the reimbursement amount for wigs provided for eligible Medicaid and NJ FamilyCare enrollees. The bill, moreover, stipulates that private health insurers, the SHBP, the SEHBP, the State Medicaid program, and the NJ FamilyCare program be prohibited from restricting coverage for wigs to individuals undergoing chemotherapy as treatment for a cancer diagnosis. Currently, the SHBP and SEHBP cover wigs for subscribers undergoing chemotherapy for a cancer diagnosis to the same extent as other items of durable medical equipment. Both the SHBP and the SEHBP cover wigs for subscribers diagnosed with alopecia, albeit to a lesser extent than for patients with a cancer diagnosis. It is unclear the number of private health insurers that include wigs as a covered benefit for subscribers, or the scope of the benefit offered by these insurers. Under current law, neither the State Medicaid program nor the NJ FamilyCare program cover wigs for enrolled individuals. The benefits established pursuant to the bill are similar to those provided in H.R.5430 and S.4708 currently pending before Congress, which require the federal Medicare program to cover wigs as durable medical equipment.

Committee Categories

Reginald Atkins (D)*,  Sterley Stanley (D)*, 

Introduced, Referred to Assembly Health Committee (on 12/12/2022)

Official Document