2008 -- S 2415

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LC01934

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2008

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A N A C T

RELATING TO INSURANCE

     Introduced By: Senators Ciccone, Alves, DaPonte, Felag, and Ruggerio

     Date Introduced: February 12, 2008

     Referred To: Senate Health & Human Services

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

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     27-18-30. Health insurance contracts -- Infertility. -- (a) Any health insurance contract,

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plan, or policy delivered or issued for delivery or renewed in this state, except contracts providing

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supplemental coverage to Medicare or other governmental programs, which includes pregnancy

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related benefits, shall provide coverage for medically necessary expenses of diagnosis and

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treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years.

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Coverage for preimplantation genetic diagnosis (PGD) in conjunction with in vitro fertilization

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(IVF) shall be provided to a married couple where at least one spouse has a balanced

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translocation. To the extent that a health insurance contract provides reimbursement for a test or

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procedure used in the diagnosis or treatment of conditions other than infertility, the tests and

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procedures shall not be excluded from reimbursement when provided attendant to the diagnosis

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and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)

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years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be

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required for those programs and/or procedures the sole purpose of which is the treatment of

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infertility.

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      (b) For the purpose of this section, "infertility" means the condition of an otherwise

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presumably healthy married individual who is unable to conceive or sustain a pregnancy during a

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period of one year or has suffered a miscarriage where at least one spouse has a balanced

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translocation.

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      (c) Notwithstanding the provisions of section 27-18-19 or any other provision to the

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contrary, this section shall apply to blanket or group policies of insurance.

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      (d) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-23. Coverage for infertility. -- (a) Any nonprofit hospital service contract, plan,

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or insurance policies delivered, issued for delivery, or renewed in this state, except contracts

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providing supplemental coverage to Medicare or other governmental programs, which includes

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pregnancy related benefits shall provide coverage for medically necessary expenses of diagnosis

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and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)

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years. Coverage for preimplantation genetic diagnosis (PGD) in conjunction with in vitro

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fertilization (IVF) shall be provided to a married couple where at least one spouse has a balanced

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translocation. To the extent that a nonprofit hospital service corporation provides reimbursement

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for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those

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tests and procedures shall not be excluded from reimbursement when provided attendant to the

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diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-

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two (42) years; provided, that a subscriber copayment, not to exceed twenty percent (20%), may

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be required for those programs and/or procedures the sole purpose of which is the treatment of

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infertility.

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      (b) For the purposes of this section, "infertility" means the condition of an otherwise

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presumably healthy married individual who is unable to conceive or sustain a pregnancy during a

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period of one year or has suffered a miscarriage where at least one spouse has a balanced

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translocation.

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      (c) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

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     27-20-20. Coverage for infertility. -- (a) Any nonprofit medical service contract, plan,

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or insurance policies delivered, issued for delivery, or renewed in this state, except contracts

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providing supplemental coverage to Medicare or other governmental programs, which includes

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pregnancy related benefits shall provide coverage for the medically necessary expenses of

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diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-

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two (42) years. Coverage for preimplantation genetic diagnosis (PGD) in conjunction with in

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vitro fertilization (IVF) shall be provided to a married couple where at least one spouse has a

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balanced translocation. To the extent that a nonprofit medical service corporation provides

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reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than

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infertility, those tests and procedures shall not be excluded from reimbursement when provided

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attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five

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(25) and forty-two (42) years. Provided, that subscriber copayment, not to exceed twenty percent

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(20%), may be required for those programs and/or procedures the sole purpose of which is the

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treatment of infertility.

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      (b) For the purposes of this section, "infertility" means the condition of an otherwise

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presumably healthy married individual who is unable to conceive or sustain a pregnancy during a

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period of one year or has suffered a miscarriage where at least one spouse has a balanced

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translocation.

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      (c) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health

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Maintenance Organizations" is hereby amended to read as follows:

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     27-41-33. Coverage for infertility. -- (a) Any health maintenance organization service

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contract plan or policy delivered, issued for delivery, or renewed in this state, except a contract

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providing supplemental coverage to Medicare or other governmental programs, which includes

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pregnancy related benefits, shall provide coverage for medically necessary expenses of diagnosis

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and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)

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years. Coverage for preimplantation genetic diagnosis (PGD) in conjunction with in vitro

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fertilization (IVF) shall be provided to a married couple where at least one spouse has a balanced

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translocation. To the extent that a health maintenance organization provides reimbursement for a

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test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests

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and procedures shall not be excluded from reimbursement when provided attendant to the

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diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-

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two (42) years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be

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required for those programs and/or procedures the sole purpose of which is the treatment of

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infertility.

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      (b) For the purpose of this section, "infertility" means the condition of an otherwise

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healthy married individual who is unable to conceive or sustain a pregnancy during a period of

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one year or has suffered a miscarriage where at least one spouse has a balanced translocation.

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      (c) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 5. This act shall take effect upon passage.

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LC01934

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE

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     This act would include coverage for preimplantation genetic diagnosis (PGD) in

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conjunction with in vitro fertilization (IVF) for a married couple where at least one spouse has a

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balanced translocation.

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     This act would take effect upon passage.

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LC01934

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