S.2063 A.38 – Coverage for Scalp Cooling

Re:      S.2063 (Stavisky)/A.38 (L. Rosenthal) – AN ACT An act to amend the insurance law, in relation to providing health insurance coverage for scalp cooling for the preservation of hair during cancer chemotherapy treatment

This legislation, S.2063/A.38 would require health insurance providers to cover scalp cooling for the preservation of hair curing cancer chemotherapy treatment. While well intentioned, the bill is unnecessary as most plans currently provide coverage for scalp cooling therapies as needed. Therefore, the New York Health Plan Association (HPA) opposes the legislation.

Creating new health insurance coverage mandates results in increased costs for individuals and employers purchasing health insurance in New York. Mandated benefit requirements pertain only to fully-insured policies, which are generally those purchased either by individuals who buy coverage on their own or receive it through a small or medium-sized business. Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers, which are governed by the Federal Employee Retirement Income Security Act (ERISA) and therefore not subject to state mandated benefits. This exemption offers self-insured employers greater control over the particular benefits they cover for their employees.

One reason large employers typically self-insure is to avoid covering certain mandated benefits. Today, more than 50 percent of the commercial market in New York is covered under a self-insured plan. As more employers self-insure, state laws mandating specific types of benefits and services affect an increasingly smaller portion of the privately insured marketplace and fall largely on small and medium-sized employers.

At a time when many New Yorkers are struggling to afford the health insurance coverage they have, this bill is ill advised and duplicates existing benefits. We urge you to say no to S.2063/A.38.