376.1222. Prostheses and scalp prostheses to be provided for children under eighteen by Medicaid, children's health insurance and the consolidated plan--no additional insurance cost--amount allowa
Prostheses and scalp prostheses to be provided for children undereighteen by Medicaid, children's health insurance and theconsolidated plan--no additional insurance cost--amount allowable.
376.1222. 1. Any health insurance policy through the Medicaidprogram pursuant to chapter 208, RSMo, the children's health insuranceprogram pursuant to sections 208.631 to 208.660, RSMo, and any health careplans issued to employees under the Missouri consolidated health care planestablished pursuant to chapter 103, RSMo, that are delivered, issued fordelivery, continued or renewed in this state on or after January 1, 2004,shall provide coverage for prostheses and expenses for scalp hairprostheses worn for hair loss suffered as a result of alopecia areata oralopecia totalis for persons eighteen years of age or younger who arecovered under a policy, program or plan pursuant to this section.
2. For purposes of this section, the following terms mean:
(1) "Prostheses", artificial appliances used to replace lost naturalstructures;
(2) "Scalp hair prostheses", artificial substitutes for scalp hairthat are made specifically for a particular individual.
3. The coverage required by this section shall not be more than amaximum benefit amount of two hundred dollars per calendar year or exceed alifetime maximum benefit amount of three thousand two hundred dollars forthose persons who select a more permanent scalp hair prosthesis. A personmay request a one-time expenditure of up to three thousand two hundreddollars. The benefits required by this section shall expire when totalbenefits paid reach three thousand two hundred dollars or when such personlisted in subsection 1 of this section reaches eighteen years of age.
4. The health care service required by this section shall not besubject to any greater deductible or co-payment than other similar healthcare services provided by the policy, program, or plan.
5. Nothing in this section shall prohibit a health insurer or healthbenefit plan from providing coverage that is greater than or more favorableto persons than the coverage provided by this section.
(L. 2003 H.B. 455)