2024 -- S 2946

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LC005844

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Cano, and Mack

     Date Introduced: April 02, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 27-18-30 and 27-18-52 of the General Laws in Chapter 27-18

entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows:

     27-18-30. Health insurance contracts — Infertility. Health insurance contracts --

Fertility healthcare.

     (a) Any health insurance contract, plan, or policy delivered or issued for delivery or

renewed in this state, except contracts providing supplemental coverage to Medicare or other

governmental programs, that includes pregnancy-related benefits, shall provide coverage for

medically necessary expenses of diagnosis and treatment of infertility for women between the ages

of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a

medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a

covered person. :

     (1) Fertility diagnostic care;

     (2) Fertility treatment if the enrollee is a fertility patient;

     (3) Standard fertility preservation services; and

     (4) In vitro laboratory services required in the course of fertility diagnostic care, fertility

treatment, and/or fertility preservation regardless of whether donor gametes or embryos are used or

if embryo(s) will be transferred to a surrogate and including preimplantation genetic diagnosis

(PGD).

     (b) A policy that provides coverage for the services required under this section, shall not:

     (1) Impose any limitations on coverage for a fertility patient solely on the basis of such

patient's age;

     (2) Require that a pregnancy loss, including, but not limited to, a miscarriage or stillbirth,

suffered during the periods referenced in subsections (f)(2) and (f)(3) of this section shall result in

the commencement of a new twelve (12) month or six (6) month period in which to determine

whether an individual is experiencing infertility;

     (3) Use any prior diagnosis or fertility treatment as a basis for excluding, limiting, or

otherwise restricting the availability of coverage required under this section;

     (4) Impose any limitations on coverage required under this section based on an individual's

use of donor gametes, donor embryos, or surrogacy;

     (5) Impose any copayments, deductibles, coinsurances, benefit maximums, waiting

periods, or other limitations on coverage that are different than any maternity benefits provided by

the health insurance policy;

     (6) Impose any exclusions, limitations, or other restrictions on coverage of fertility

medications that are different from those imposed on any other prescription medications;

     (7) Impose different limitations on coverage for, provide different benefits to, or impose

different requirements on a fertility patient who is a part of any of a class of persons whose rights

are protected pursuant to § 23-17-19.1; and

     (8) Base any limitations imposed by the policy on anything other than the medical

assessment of an individual's licensed physician and clinical guidelines adopted by the policy.

     (c) Any clinical guidelines used for a policy subject to the requirements of this section

shall:

     (1) Be based on current guidelines developed by the American Society for Reproductive

Medicine, its successor organization, or a comparable organization;

     (2) Cite with specificity any data or scientific reference relied upon;

     (3) Be maintained in written form; and

     (4) Be made available to an individual in writing upon request.

     (d) A policy that provides coverage for the services required under this section may:

     (1) Limit such coverage to four (4) completed oocyte retrievals, with unlimited embryo

transfers;

     (2) Limit such coverage for intrauterine insemination to a lifetime maximum benefit of six

(6) cycles;

     (3) Limit coverage for in vitro fertilization to those individuals who have been unable to

achieve or sustain a pregnancy to live birth through less expensive and medically viable fertility

LC005844 - Page 2 of 14

treatment or procedures covered under such policy; and

     (4) Require that treatment or procedures that must be covered as provided in this section

be performed at facilities that conform to the standards and guidelines developed by the American

Society of Reproductive Medicine or the Society for Reproductive Endocrinology and Infertility.

     (e) Any health insurance policy issued pursuant to subsection (a) of this section shall not

be required to provide coverage for:

     (1) Any experimental fertility procedure; or

     (2) Any non-medical fees related to procuring gametes, embryos, or surrogacy services.

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

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

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

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

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

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

     (b)(f) For purposes of this section, “infertility” means the condition of an otherwise

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

one year. Means: (1) The presence of a condition recognized by a licensed physician as a cause of

loss or impairment of fertility, based on an individual's medical, sexual and reproductive history,

age, physical findings, diagnostic testing, or any combination of those factors; (2) An individual's

inability to achieve pregnancy after twelve (12) months of unprotected sexual intercourse when the

individual and their partner have the necessary gametes to achieve pregnancy; (3) An individual's

inability to achieve pregnancy after six (6) months of unprotected sexual intercourse due to such

individual's age; or (4) As defined by the American Society of Reproductive Medicine, its successor

organization, or comparable organization.

     (c)(g) For purposes of this section, “standard fertility-preservation services” means

procedures (1) Procedures consistent with established medical practices and professional guidelines

published by the American Society for Reproductive Medicine, the American Society of Clinical

Oncology, or other reputable professional medical organizations., their successor organizations, or

a comparable organization, for an individual who has a medical or genetic condition or who is

expected to undergo treatment that may directly or indirectly cause a risk of impairment of fertility,

and (2) includes, but is not limited to, the procurement and cryopreservation of gametes, embryos,

and reproductive material, and storage from the date of cryopreservation until the individual

reaches the age of thirty (30), or for a period of not less than five (5) years, whichever is later.

     (h) For the purposes of this section, "fertility patient" means: (1) An individual diagnosed

LC005844 - Page 3 of 14

with infertility; (2) An individual who is, independently or with their partner, at increased risk of

transmitting a serious inheritable genetic or chromosomal abnormality to a child; (3) An individual

unable to achieve a pregnancy as an individual or with a partner because the individual or individual

and their partner does not have the necessary gametes to achieve a pregnancy; or (4) An individual

for whom fertility preservation services are medically necessary.

     (i) For the purposes of this section, "fertility treatment" means procedures, products,

genetic testing, medications, and services intended to achieve pregnancy that result in a live birth

and that are provided in a manner consistent with established medical practice and professional

guidelines published by the American Society for Reproductive Medicine, its successor

organization, or a comparable organization.

     (j) For the purposes of this section, "experimental fertility procedure" means a procedure

for which the published medical evidence is not sufficient for the American Society for

Reproductive Medicine, its successor organization, or a comparable organization to regard the

procedure as established medical practice.

     (k) For the purposes of this section, "fertility diagnostic care" means procedures, products,

medications, and services intended to provide information and counseling about an individual's

fertility, including laboratory assessments and imaging studies.

     (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by

surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or

processes.

     (e) For purposes of this section, “may directly or indirectly cause” means treatment with a

likely side effect of infertility as established by the American Society for Reproductive Medicine,

the American Society of Clinical Oncology, or other reputable professional organizations.

     (f)(l) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,

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

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

thousand dollars ($100,000).

     (n) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a

technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic

disorders prior to their transfer to the uterus.

     27-18-52. Genetic testing.

     (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and

providers shall be prohibited from releasing genetic information without prior written authorization

of the individual. Written authorization shall be required for each disclosure and include to whom

LC005844 - Page 4 of 14

the disclosure is being made. An exception shall exist for those participating in research settings

governed by the Federal Policy for the Protection of Human Research Subjects (also known as

“The Common Rule”). Tests conducted purely for research are excluded from the definition, as are

tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.

     (b) No individual or group health insurance contract, plan, or policy delivered, issued for

delivery, or renewed in this state which provides health insurance medical coverage that includes

coverage for physician services in a physician’s office, and every policy which provides major

medical or similar comprehensive-type coverage excluding disability income, long term care and

insurance supplemental policies which only provide coverage for specified diseases or other

supplemental policies, shall:

     (1) Use a genetic test or request for genetic tests or the results of a genetic test to reject,

deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect

a group or an individual health insurance policy, contract, or plan;

     (2) Request or require a genetic test for the purpose of determining whether or not to issue

or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine

covered benefits and services;

     (3) Release the results of a genetic test without the prior written authorization of the

individual from whom the test was obtained, except in a format whereby individual identifiers are

removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient

of information pursuant to this section may use or disclose this information solely to carry out the

purpose for which the information was disclosed. Authorization shall be required for each

redisclosure; an exception shall exist for participating in research settings governed by the Federal

Policy for the Protection of Human Research Subjects (also known as “The Common Rule”).

     (4) Request or require information as to whether an individual has ever had a genetic test,

or participated in genetic testing of any kind, whether for clinical or research purposes.

     (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,

RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related

genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include

predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or

prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be

included provided there is an approved release by a parent or guardian. Tests for metabolites are

covered only when they are undertaken with high probability that an excess of deficiency of the

metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not

mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs

LC005844 - Page 5 of 14

or for HIV infections.

     (d) Any health insurance contract, plan, or policy delivered or issued for delivery or

renewed in this state, except contracts providing supplemental coverage to Medicare or other

governmental programs, that includes pregnancy-related benefits, shall provide coverage for the

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

and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with

in vitro fertilization (IVF). For purposes of this section:

     (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction

with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer

to the uterus;

     (2) "Infertility" means the condition of an otherwise presumably healthy individual who is

unable to conceive or sustain a pregnancy during a period of one year.

     SECTION 2. Sections 27-19-23 and 27-19-44 of the General Laws in Chapter 27-19

entitled "Nonprofit Hospital Service Corporations" are hereby amended to read as follows:

     27-19-23. Coverage for infertility.

     (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for

delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare

or other governmental programs, that includes pregnancy-related benefits, shall provide coverage

for medically necessary expenses of diagnosis and treatment of infertility for women between the

ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis

(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation

services when a medically necessary medical treatment may directly or indirectly cause iatrogenic

infertility to a covered person. To the extent that a nonprofit hospital service corporation provides

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

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

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

(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent

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

treatment of infertility.

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

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

one year.

     (c) For purposes of this section, “standard fertility-preservation services” means

procedures consistent with established medical practices and professional guidelines published by

LC005844 - Page 6 of 14

the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

other reputable professional medical organizations.

     (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by

surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or

processes.

     (e) For purposes of this section, “may directly or indirectly cause” means treatment with a

likely side effect of infertility as established by the American Society for Reproductive Medicine,

the American Society of Clinical Oncology, or other reputable professional organizations.

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

thousand dollars ($100,000).

     (g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a

technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic

disorders prior to their transfer to the uterus.

     27-19-44. Genetic testing.

     (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and

providers shall be prohibited from releasing genetic information without prior written authorization

of the individual. Written authorization shall be required for each disclosure and include to whom

the disclosure is being made. An exception shall exist for those participating in research settings

governed by the federal policy for the protection of human research subjects (also known as “The

Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests

for somatic (as opposed to heritable) mutations, and testing for forensic purposes.

     (b) No nonprofit health service corporation subject to the provisions of this chapter shall:

     (1) Use a genetic test or request for a genetic test or the results of a genetic test or other

genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the

terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or

plan;

     (2) Request or require a genetic test for the purpose of determining whether or not to issue

or renew a group, individual health benefits coverage, to set reimbursement/copay levels, or

determine covered benefits and services;

     (3) Release the results of a genetic test without the prior written authorization of the

individual from whom the test was obtained, except in a format by which individual identifiers are

removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient

of information pursuant to this section may use or disclose the information solely to carry out the

purpose for which the information was disclosed. Authorization shall be required for each

LC005844 - Page 7 of 14

redisclosure. An exception shall exist for participation in research settings governed by the federal

policy for the protection of human research subjects (also known as “The Common Rule”); or

     (4) Request or require information as to whether an individual has ever had a genetic test,

or participated in genetic testing of any kind, whether for clinical or research purposes.

     (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,

RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related

genotypes, mutations, phenotypes, or karyotypes for clinical purposes. These purposes include

predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or

prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be

included provided there is an approved release by a parent or guardian. Tests for metabolites are

covered only when they are undertaken with high probability that an excess of deficiency of the

metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not

mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs

or for HIV infection.

     (d) Any health insurance contract, plan, or policy delivered or issued for delivery or

renewed in this state, except contracts providing supplemental coverage to Medicare or other

governmental programs, that includes pregnancy-related benefits, shall provide coverage for the

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

and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with

in vitro fertilization (IVF). For purposes of this section:

     (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction

with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer

to the uterus;

     (2) "Infertility" means the condition of an otherwise presumably healthy individual who is

unable to conceive or sustain a pregnancy during a period of one year.

     SECTION 3. Sections 27-20-20 and 27-20-39 of the General Laws in Chapter 27-20

entitled "Nonprofit Medical Service Corporations" are hereby amended to read as follows:

     27-20-20. Coverage for infertility.

     (a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for

delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare

or other governmental programs, that includes pregnancy-related benefits, shall provide coverage

for the medically necessary expenses of diagnosis and treatment of infertility for women between

the ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis

(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation

LC005844 - Page 8 of 14

services when a medically necessary medical treatment may directly or indirectly cause iatrogenic

infertility to a covered person. To the extent that a nonprofit medical service corporation provides

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

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

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

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

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

treatment of infertility.

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

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

one year.

     (c) For purposes of this section, “standard fertility-preservation services” means

procedures consistent with established medical practices and professional guidelines published by

the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

other reputable professional medical organizations.

     (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by

surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or

processes.

     (e) For purposes of this section, “may directly or indirectly cause” means treatment with a

likely side effect of infertility as established by the American Society for Reproductive Medicine,

the American Society of Clinical Oncology, or other reputable professional organizations.

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

thousand dollars ($100,000).

     (g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a

technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic

disorders prior to their transfer to the uterus.

     27-20-39. Genetic testing.

     (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and

providers shall be prohibited from releasing genetic information without prior written authorization

of the individual. Written authorization shall be required for each disclosure and include to whom

the disclosure is being made. An exception shall exist for those participating in research settings

governed by the federal policy for the protection of human research subjects (also known as “The

Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests

for somatic (as opposed to heritable) mutations, and testing for forensic purposes.

LC005844 - Page 9 of 14

     (b) No nonprofit health insurer subject to the provisions of this chapter shall:

     (1) Use a genetic test or request for a genetic test or the results of a genetic test to reject,

deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect

a group or individual’s health insurance policy, contract, or plan;

     (2) Request or require a genetic test for the purpose of determining whether or not to issue

or renew health benefits coverage, to set reimbursement/copay levels, or determine covered

benefits and services;

     (3) Release the results of a genetic test without the prior written authorization of the

individual from whom the test was obtained, except in a format by which individual identifiers are

removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient

of information pursuant to this section may use or disclose the information solely to carry out the

purpose for which the information was disclosed. Authorization shall be required for each

redisclosure. An exception shall exist for participation in research settings governed by the federal

policy for the protection of human research subjects (also known as “The Common Rule”); or

     (4) Request or require information as to whether an individual has ever had a genetic test,

or participated in genetic testing of any kind, whether for clinical or research purposes.

     (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,

RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related

genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those purposes include

predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or

prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be

included provided there is an approved release by a parent or guardian. Tests for metabolites are

covered only when they are undertaken with high probability that an excess of deficiency of the

metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not

mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs

or for HIV infections.

     (d) Any health insurance contract, plan, or policy delivered or issued for delivery or

renewed in this state, except contracts providing supplemental coverage to Medicare or other

governmental programs, that includes pregnancy-related benefits, shall provide coverage for the

expenses of diagnosis and treatment of infertility for individuals between the ages of twenty-five

(25) and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction

with in vitro fertilization (IVF). For purposes of this section:

     (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction

with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer

LC005844 - Page 10 of 14

to the uterus;

     (2) "Infertility" means the condition of an otherwise presumably healthy individual who is

unable to conceive or sustain a pregnancy during a period of one year.

     SECTION 4. Sections 27-41-33 and 27-41-53 of the General Laws in Chapter 27-41

entitled "Health Maintenance Organizations" are hereby amended to read as follows:

     27-41-33. Coverage for infertility.

     (a) Any health maintenance organization service contract plan or policy delivered, issued

for delivery, or renewed in this state, except a contract providing supplemental coverage to

Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide

coverage for medically necessary expenses of diagnosis and treatment of infertility for women

between the ages of twenty-five (25) and forty-two (42), including preimplantation genetic

diagnosis (PGD) in conjunction with in vitro fertilization (IVF), years and for standard fertility-

preservation services when a medically necessary medical treatment may directly or indirectly

cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization

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

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

provided attendant to the diagnosis and treatment of infertility for women between the ages of

twenty-five (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed

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

which is the treatment of infertility.

     (b) For purposes of this section, “infertility” means the condition of an otherwise healthy

individual who is unable to conceive or sustain a pregnancy during a period of one year.

     (c) For purposes of this section, “standard fertility-preservation services” means

procedures consistent with established medical practices and professional guidelines published by

the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

other reputable professional medical organizations.

     (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by

surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or

processes.

     (e) For purposes of this section, “may directly or indirectly cause” means treatment with a

likely side effect of infertility as established by the American Society for Reproductive Medicine,

the American Society of Clinical Oncology, or other reputable professional organizations.

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

thousand dollars ($100,000).

LC005844 - Page 11 of 14

     (g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a

technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic

disorders prior to their transfer to the uterus.

     27-41-53. Genetic testing.

     (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and

providers shall be prohibited from releasing genetic information without prior written authorization

of the individual. Written authorization shall be required for each disclosure and include to whom

the disclosure is being made. An exception shall exist for those participating in research settings

governed by the federal policy for the protection of human research subjects (also known as “The

Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests

for somatic (as opposed to heritable) mutations, and testing for forensic purposes.

     (b) No health maintenance organization subject to the provisions of this chapter shall:

     (1) Use a genetic test or request for genetic test or the results of a genetic test to reject,

deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect

a group or an individual’s health insurance policy contract, or plan;

     (2) Request or require a genetic test for the purpose of determining whether or not to issue

or renew an individual’s health benefits coverage, to set reimbursement/copay levels, or determine

covered benefits and services;

     (3) Release the results of a genetic test without the prior written authorization of the

individual from whom the test was obtained, except in a format where individual identifiers are

removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient

of information pursuant to this section may use or disclose the information solely to carry out the

purpose for which the information was disclosed. Authorization shall be required for each re-

disclosure. An exception shall exist for participation in research settings governed by the federal

policy for the protection of human research subjects (also known as “The Common Rule”); or

     (4) Request or require information as to whether an individual has ever had a genetic test,

or participated in genetic testing of any kind, whether for clinical or research purposes.

     (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,

RNA, chromosomes, protein, and certain metabolites in order to detect heritable inheritable

disease-related genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those

purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical

diagnosis or prognosis. Prenatal, newborn, and carrier screening, and testing in high-risk families

may be included provided there is an approved release by a parent or guardian. Tests for metabolites

are covered only when they are undertaken with high probability that an excess or deficiency of the

LC005844 - Page 12 of 14

metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not

mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs

or for HIV infections.

     (d) Any health insurance contract, plan, or policy delivered or issued for delivery or

renewed in this state, except contracts providing supplemental coverage to Medicare or other

governmental programs, that includes pregnancy-related benefits, shall provide coverage for the

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

and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with

in vitro fertilization (IVF). For purposes of this section:

     (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction

with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer

to the uterus;

     (2) "Infertility" means the condition of an otherwise presumably healthy individual who is

unable to conceive or sustain a pregnancy during a period of one year.

     SECTION 5. This act shall take effect on January 1, 2025.

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LC005844

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would mandate all insurance contracts, plans or policies provide insurance

coverage for the expense of diagnosing and treating infertility for women between the ages of

twenty-five and forty-two years including preimplantation genetic diagnosis (PGD) in conjunction

with in vitro fertilization (IVF).

     This act would take effect on January 1, 2025.

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LC005844

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LC005844 - Page 14 of 14