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HB 818

Regards insurance, Medicaid coverage of scalp cooling systems

136th Legislature (2025-2026) Introduced by Kevin Ritter

The bill requires Ohio health insurers and Medicaid to cover scalp cooling systems for patients undergoing cancer chemotherapy.

Referred to committee
#commerce #healthcare #healthandhumanservices #insurance #medicaid
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Bill Summary · HB 818

Summary of HB 818 (Ohio, 136th General Assembly)

Purpose and Intent

HB 818 aims to require insurance policies and Medicaid to cover scalp cooling systems for individuals undergoing cancer chemotherapy. The legislation defines scalp cooling systems and obligates certain health coverage programs to provide benefits for the expense of these devices when used to reduce or prevent chemotherapy-induced hair loss.

Key Provisions

Definition

  • A “scalp cooling system” is defined as a device used to cool the human scalp to prevent or reduce hair loss during cancer chemotherapy. It must be designed for repeated use and primarily serve a medical purpose.

Private Health Insurance Coverage (Basic Health Care Services)

  • Section 1751.64: For health insuring corporations (policies delivering or renewing in Ohio) that cover cancer chemotherapy, the policy must provide benefits for the expense of a scalp cooling system.
  • Applies notwithstanding current restrictions in section 3901.71 of the Revised Code.

Individual and Group Health Insurance Coverage

  • Section 3923.66: For individual or group sickness and accident insurance policies issued in Ohio that cover cancer chemotherapy, the policy must provide benefits for the expense of a scalp cooling system.
  • Applies notwithstanding current restrictions in section 3901.71 of the Revised Code.

Public Employee Benefit Plans

  • Section 3923.67: For public employee benefit plans established or modified in Ohio that cover cancer chemotherapy, the plan must provide benefits for the expense of a scalp cooling system.
  • Applies notwithstanding current restrictions in section 3901.71 of the Revised Code.

Medicaid Coverage

  • Section 5164.11: The Ohio Medicaid program must cover scalp cooling systems for recipients undergoing cancer chemotherapy.
  • The Medicaid director may adopt rules under section 5164.02 to implement this section.
  • The definition of “scalp cooling system” aligns with the definition in section 1751.64.

Who Is Affected

  • Health insurance policyholders in Ohio with
    • Basic health care services coverage (as provided by health insuring corporations)
    • Individual or group sickness and accident policies that cover cancer chemotherapy
    • Public employee benefit plans that cover cancer chemotherapy
  • Medicaid recipients undergoing cancer chemotherapy in Ohio
  • Providers and insurers that administer these policies, who must implement coverage for scalp cooling systems

Procedural and Timeline Details

  • Effective date and specific implementation timeline are not provided in the introduced text. The bill authorizes the relevant agencies (e.g., Medicaid director) to adopt implementing rules as necessary to carry out the coverage requirements.
  • The bill explicitly states that these coverage requirements apply “notwithstanding” existing sections (3901.71), indicating an override of current insurance cost-sharing or coverage limitations for scalp cooling systems within the scope of the new requirements.

Notable Considerations

  • The act treats scalp cooling systems as medically necessary devices for the purposes of insurance and Medicaid coverage, emphasizing repeated-use devices designed for medical purposes.
  • The bill does not specify coverage limits, copayments, or eligibility criteria beyond the types of plans affected and the connection to cancer chemotherapy treatment.

If you’d like, I can add a side-by-side comparison with current law (without HB 818) to illustrate the changes, or draft a one-page briefing for policymakers or constituents.

Compiled from official sources — confirm details with the bill’s official record.

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