2025 -- H 5629 | |
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LC000882 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2025 | |
____________ | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND INSURANCE POLICIES | |
| |
Introduced By: Representatives Alzate, Ajello, Kislak, Felix, Furtado, Stewart, Kazarian, | |
Date Introduced: February 26, 2025 | |
Referred To: House Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident |
2 | and Sickness Insurance Policies" is hereby amended to read as follows: |
3 | 27-18-30. Health insurance contracts — Infertility. |
4 | (a) Any health insurance contract, plan, or policy delivered or issued for delivery or |
5 | renewed in this state, except contracts providing supplemental coverage to Medicare or other |
6 | governmental programs, that includes pregnancy-related benefits, shall provide coverage for |
7 | medically necessary expenses of diagnosis and treatment of infertility for women between the ages |
8 | of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services when a |
9 | medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a |
10 | covered person. To the extent that a health insurance contract provides reimbursement for a test or |
11 | procedure used in the diagnosis or treatment of conditions other than infertility, the tests and |
12 | procedures shall not be excluded from reimbursement when provided attendant to the diagnosis |
13 | and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) |
14 | years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required |
15 | for those programs and/or procedures the sole purpose of which is the treatment of infertility. |
16 | (b) For purposes of this section, “infertility” means the condition of an otherwise |
17 | presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of |
18 | one year. |
19 | (b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
| |
1 | this section shall apply to blanket or group policies of insurance. |
2 | (c) For the purposes of this section, the following terms shall have the following meanings: |
3 | (1) “Infertility” means: |
4 | (i) The presence of a condition recognized by a healthcare provider as a cause of loss or |
5 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
6 | physical findings, diagnostic testing, or any combination of those factors; |
7 | (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
8 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
9 | partner have the necessary gametes to establish a pregnancy; |
10 | (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected |
11 | sexual intercourse due to an individual's age when the individual and the individual’s partner have |
12 | the necessary gametes to establish pregnancy; |
13 | (iv) An individual’s inability to achieve pregnancy as an individual or with a partner |
14 | because the individual or the individual and the individual’s partner do not have the necessary |
15 | gametes to achieve a pregnancy; |
16 | (v) An individual’s increased risk, independently or with the individual’s partner, of |
17 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or |
18 | (vi) As defined by the American Society of Reproductive Medicine, its successor |
19 | organization, or comparable organization. |
20 | (vii) Pregnancy resulting in a loss does not cause the time period of trying to establish a |
21 | pregnancy to be restarted. |
22 | (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard |
23 | fertility-preservation services" means procedures consistent with established medical practices and |
24 | professional guidelines published by the American Society for Reproductive Medicine, the |
25 | American Society of Clinical Oncology, or other reputable professional medical organizations, its |
26 | successor organization, or a comparable organization, for an individual who has a medical or |
27 | genetic condition or who is expected to undergo treatment that has a possible side effect of or may |
28 | directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the |
29 | procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. |
30 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
31 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
32 | processes. |
33 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
34 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
| LC000882 - Page 2 of 13 |
1 | the American Society of Clinical Oncology, or other reputable professional organizations. |
2 | (f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
3 | this section shall apply to blanket or group policies of insurance. |
4 | (g) The health insurance contract may limit coverage to a lifetime cap of one hundred |
5 | thousand dollars ($100,000). |
6 | (d) Coverage for the treatment of infertility under this section shall be provided without |
7 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
8 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
9 | or sexual orientation. |
10 | (e) Coverage for the treatment of infertility under this section shall include: |
11 | (1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those |
12 | oocyte retrievals or from any oocyte retrieval; |
13 | (2) The medical costs related to an embryo transfer to be made from or on behalf of an |
14 | insured to a third party; and |
15 | (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo |
16 | will be transferred to a surrogate. |
17 | (f) An insurer described in subsection (a) of this section shall not impose any of the |
18 | following: |
19 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
20 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
21 | prescription of fertility medications, different from those imposed on benefits for services not |
22 | related to infertility; |
23 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
24 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
25 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
26 | required benefits; |
27 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
28 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
29 | on, a class protected under § 23-17-19.1, than that provided to other insureds; |
30 | (4) Impose any limitations on coverage required under this section based on an individual's |
31 | use of donor gametes, donor embryos or surrogacy; |
32 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
33 | are different from those imposed on any other prescription medications; or |
34 | (6) Limitations under the policy based on anything other than the medical assessment of |
| LC000882 - Page 3 of 13 |
1 | an individual’s licensed healthcare provider. |
2 | (g) An insurer described in subsection (a) of this section of this section shall provide |
3 | coverage under this section regardless of whether the insured foregoes a particular fertility |
4 | treatment or procedure, if the insured’s healthcare provider determines that the treatment or |
5 | procedures is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or |
6 | embryos. |
7 | (h) This section does not interfere with the clinical judgment of a healthcare provider. Any |
8 | clinical guidelines used for a policy subject to the requirements of this section shall be based on |
9 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
10 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
11 | the American College of Obstetrics and Gynecology. |
12 | SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit |
13 | Hospital Service Corporations" is hereby amended to read as follows: |
14 | 27-19-23. Coverage for infertility. |
15 | (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for |
16 | delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare |
17 | or other governmental programs, that includes pregnancy-related benefits, shall provide coverage |
18 | for medically necessary expenses of diagnosis and treatment of infertility for women between the |
19 | ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services |
20 | when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility |
21 | to a covered person. To the extent that a nonprofit hospital service corporation provides |
22 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
23 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
24 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
25 | (25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent |
26 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
27 | treatment of infertility. |
28 | (b) For purposes of this section, “infertility” means the condition of an otherwise |
29 | presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of |
30 | one year. |
31 | (b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
32 | this section shall apply to blanket or group policies of insurance. |
33 | (c) For the purposes of this section, the following terms shall have the following meanings: |
34 | (1) “Infertility” means: |
| LC000882 - Page 4 of 13 |
1 | (i) The presence of a condition recognized by a healthcare provider as a cause of loss or |
2 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
3 | physical findings, diagnostic testing, or any combination of those factors; |
4 | (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
5 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
6 | partner have the necessary gametes to establish a pregnancy; |
7 | (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected |
8 | sexual intercourse due to an individual's age when the individual and the individual’s partner have |
9 | the necessary gametes to establish pregnancy; |
10 | (iv) An individual’s inability to achieve pregnancy as an individual or with a partner |
11 | because the individual or the individual and the individual’s partner do not have the necessary |
12 | gametes to achieve a pregnancy; |
13 | (v) An individual’s increased risk, independently or with the individual’s partner, of |
14 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or |
15 | (vi) As defined by the American Society of Reproductive Medicine, its successor |
16 | organization, or comparable organization. Pregnancy resulting in a loss does not cause the time |
17 | period of trying to establish a pregnancy to be restarted. |
18 | (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard |
19 | fertility-preservation services" means procedures consistent with established medical practices and |
20 | professional guidelines published by the American Society for Reproductive Medicine, the |
21 | American Society of Clinical Oncology, or other reputable professional medical organizations, its |
22 | successor organization, or a comparable organization, for an individual who has a medical or |
23 | genetic condition or who is expected to undergo treatment that has a possible side effect of or may |
24 | directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the |
25 | procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. |
26 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
27 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
28 | processes. |
29 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
30 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
31 | the American Society of Clinical Oncology, or other reputable professional organizations. |
32 | (f) The health insurance contract may limit coverage to a lifetime cap of one hundred |
33 | thousand dollars ($100,000). |
34 | (d) Coverage for the treatment of infertility under this section must be provided without |
| LC000882 - Page 5 of 13 |
1 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
2 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
3 | or sexual orientation. |
4 | (e) Coverage for the treatment of infertility under this section must include: |
5 | (1) At least four complete oocyte retrievals with unlimited embryo transfers from those |
6 | oocyte retrievals or from any oocyte retrieval; |
7 | (2) The medical costs related to an embryo transfer to be made from or on behalf of an |
8 | insured to a third party; and |
9 | (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo |
10 | will be transferred to a surrogate. |
11 | (f) An insurer described in subsection (a) of this section shall not impose any of the |
12 | following: |
13 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
14 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
15 | prescription of fertility medications, different from those imposed on benefits for services not |
16 | related to infertility; |
17 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
18 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
19 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
20 | required benefits; |
21 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
22 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
23 | on, a class protected under § 23-17-19.1, than that provided to other insureds; |
24 | (4) Impose any limitations on coverage required under this section based on an individual's |
25 | use of donor gametes, donor embryos or surrogacy; |
26 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
27 | are different from those impose on any other prescription medications; or |
28 | (6) Limitations under the policy based on anything other than the medical assessment of |
29 | an individual’s license healthcare provider. |
30 | (g) An insurer described in subsection (a) of this section shall provide coverage under this |
31 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
32 | insured’s healthcare provider determines that the treatment or procedures is likely to be |
33 | unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. |
34 | (h) This section does not interfere with the clinical judgment of a healthcare provider. Any |
| LC000882 - Page 6 of 13 |
1 | clinical guidelines used for a policy subject to the requirements of this section must be based on |
2 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
3 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
4 | the American College of Obstetrics and Gynecology. |
5 | SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit |
6 | Medical Service Corporations" is hereby amended to read as follows: |
7 | 27-20-20. Coverage for infertility. |
8 | (a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for |
9 | delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare |
10 | or other governmental programs, that includes pregnancy-related benefits, shall provide coverage |
11 | for the medically necessary expenses of diagnosis and treatment of infertility for women between |
12 | the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services |
13 | when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility |
14 | to a covered person. To the extent that a nonprofit medical service corporation provides |
15 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
16 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
17 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
18 | (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent |
19 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
20 | treatment of infertility. |
21 | (b) For purposes of this section, “infertility” means the condition of an otherwise |
22 | presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of |
23 | one year. |
24 | (b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
25 | this section shall apply to blanket or group policies of insurance. |
26 | (c) For the purposes of this section, the following terms shall have the following meanings: |
27 | (1) “Infertility” means: |
28 | (i) The presence of a condition recognized by a healthcare provider as a cause of loss or |
29 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
30 | physical findings, diagnostic testing, or any combination of those factors; |
31 | (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
32 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
33 | partner have the necessary gametes to establish a pregnancy; |
34 | (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected |
| LC000882 - Page 7 of 13 |
1 | sexual intercourse due to an individual's age when the individual and the individual’s partner have |
2 | the necessary gametes to establish pregnancy; |
3 | (iv) An individual’s inability to achieve pregnancy as an individual or with a partner |
4 | because the individual or the individual and the individual’s partner do not have the necessary |
5 | gametes to achieve a pregnancy; |
6 | (v) An individual’s increased risk, independently or with the individual’s partner, of |
7 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or |
8 | (vi) As defined by the American Society of Reproductive Medicine, its successor |
9 | organization, or comparable organization. Pregnancy resulting in a loss does not cause the time |
10 | period of trying to establish a pregnancy to be restarted. |
11 | (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard |
12 | fertility-preservation services" means procedures consistent with established medical practices and |
13 | professional guidelines published by the American Society for Reproductive Medicine, the |
14 | American Society of Clinical Oncology, or other reputable professional medical organizations, its |
15 | successor organization, or a comparable organization, for an individual who has a medical or |
16 | genetic condition or who is expected to undergo treatment that has a possible side effect of or may |
17 | directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the |
18 | procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. |
19 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
20 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
21 | processes. |
22 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
23 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
24 | the American Society of Clinical Oncology, or other reputable professional organizations. |
25 | (f) The health insurance contract may limit coverage to a lifetime cap of one hundred |
26 | thousand dollars ($100,000). |
27 | (d) Coverage for the treatment of infertility under this section must be provided without |
28 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
29 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
30 | or sexual orientation. |
31 | (e) Coverage for the treatment of infertility under this section must include: |
32 | (1) At least four complete oocyte retrievals with unlimited embryo transfers from those |
33 | oocyte retrievals or from any oocyte retrieval; |
34 | (2) The medical costs related to an embryo transfer to be made from or on behalf of an |
| LC000882 - Page 8 of 13 |
1 | insured to a third party; and |
2 | (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo |
3 | will be transferred to a surrogate. |
4 | (f) An insurer described in subsection (a) of this section shall not impose any of the |
5 | following: |
6 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
7 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
8 | prescription of fertility medications, different from those imposed on benefits for services not |
9 | related to infertility; |
10 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
11 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
12 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
13 | required benefits; |
14 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
15 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
16 | on, a class protected under § 23-17-19.1, than that provided to other insureds; |
17 | (4) Impose any limitations on coverage required under this section based on an individual's |
18 | use of donor gametes, donor embryos or surrogacy; |
19 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
20 | are different from those impose on any other prescription medications; or |
21 | (6) Limitations under the policy based on anything other than the medical assessment of |
22 | an individual’s license healthcare provider. |
23 | (g) An insurer described in subsection (a) of this section shall provide coverage under this |
24 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
25 | insured’s healthcare provider determines that the treatment or procedures is likely to be |
26 | unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. |
27 | (h) This section does not interfere with the clinical judgment of a healthcare provider. Any |
28 | clinical guidelines used for a policy subject to the requirements of this section must be based on |
29 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
30 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
31 | the American College of Obstetrics and Gynecology. |
32 | SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health |
33 | Maintenance Organizations" is hereby amended to read as follows: |
34 | 27-41-33. Coverage for infertility. |
| LC000882 - Page 9 of 13 |
1 | (a) Any health maintenance organization service contract plan or policy delivered, issued |
2 | for delivery, or renewed in this state, except a contract providing supplemental coverage to |
3 | Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide |
4 | coverage for medically necessary expenses of diagnosis and treatment of infertility for women |
5 | between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation |
6 | services when a medically necessary medical treatment may directly or indirectly cause iatrogenic |
7 | infertility to a covered person. To the extent that a health maintenance organization provides |
8 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
9 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
10 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
11 | (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent |
12 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
13 | treatment of infertility. |
14 | (b) For purposes of this section, “infertility” means the condition of an otherwise healthy |
15 | individual who is unable to conceive or sustain a pregnancy during a period of one year. |
16 | (b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
17 | this section shall apply to blanket or group policies of insurance. |
18 | (c) For the purposes of this section, the following terms shall have the following meanings: |
19 | (i) (1) “Infertility” means: |
20 | (ii) The presence of a condition recognized by a healthcare provider as a cause of loss or |
21 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
22 | physical findings, diagnostic testing, or any combination of those factors; |
23 | (iii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
24 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
25 | partner have the necessary gametes to establish a pregnancy; |
26 | (iv) An individual's inability to establish a pregnancy after six (6) months of unprotected |
27 | sexual intercourse due to an individual's age when the individual and the individual’s partner have |
28 | the necessary gametes to establish pregnancy; |
29 | (v) An individual’s inability to achieve pregnancy as an individual or with a partner |
30 | because the individual or the individual and the individual’s partner do not have the necessary |
31 | gametes to achieve a pregnancy; |
32 | (vi) An individual’s increased risk, independently or with the individual’s partner, of |
33 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or |
34 | (vi) As defined by the American Society of Reproductive Medicine, its successor |
| LC000882 - Page 10 of 13 |
1 | organization, or comparable organization. Pregnancy resulting in a loss does not cause the time |
2 | period of trying to establish a pregnancy to be restarted. |
3 | (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard |
4 | fertility-preservation services" means procedures consistent with established medical practices and |
5 | professional guidelines published by the American Society for Reproductive Medicine, the |
6 | American Society of Clinical Oncology, or other reputable professional medical organizations, its |
7 | successor organization, or a comparable organization, for an individual who has a medical or |
8 | genetic condition or who is expected to undergo treatment that has a possible side effect of or may |
9 | directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the |
10 | procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. |
11 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
12 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
13 | processes. |
14 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
15 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
16 | the American Society of Clinical Oncology, or other reputable professional organizations. |
17 | (f) The health insurance contract may limit coverage to a lifetime cap of one hundred |
18 | thousand dollars ($100,000). |
19 | (d) Coverage for the treatment of infertility under this section must be provided without |
20 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
21 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
22 | or sexual orientation. |
23 | (e) Coverage for the treatment of infertility under this section must include: |
24 | (1) At least four complete oocyte retrievals with unlimited embryo transfers from those |
25 | oocyte retrievals or from any oocyte retrieval; |
26 | (2) The medical costs related to an embryo transfer to be made from or on behalf of an |
27 | insured to a third party; and |
28 | (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo |
29 | will be transferred to a surrogate. |
30 | (f) An insurer described in subsection (a) of this section shall not impose any of the |
31 | following: |
32 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
33 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
34 | prescription of fertility medications, different from those imposed on benefits for services not |
| LC000882 - Page 11 of 13 |
1 | related to infertility; |
2 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
3 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
4 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
5 | required benefits; |
6 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
7 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
8 | on, a class protected under § 23-17-19.1, than that provided to other insureds; |
9 | (4) Impose any limitations on coverage required under this section based on an individual's |
10 | use of donor gametes, donor embryos or surrogacy; |
11 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
12 | are different from those impose on any other prescription medications; or |
13 | (6) Limitations under the policy based on anything other than the medical assessment of |
14 | an individual’s license healthcare provider. |
15 | (g) An insurer described in subsection (a) of this section shall provide coverage under this |
16 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
17 | insured’s healthcare provider determines that the treatment or procedures is likely to be |
18 | unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. |
19 | (h) This section does not interfere with the clinical judgment of a healthcare provider. Any |
20 | clinical guidelines used for a policy subject to the requirements of this section must be based on |
21 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
22 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
23 | the American College of Obstetrics and Gynecology. |
24 | SECTION 5. This act shall take effect on January 1, 2026. |
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LC000882 | |
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| LC000882 - Page 12 of 13 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND INSURANCE POLICIES | |
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1 | This act would amend the current law on health insurance coverage for fertility diagnostic |
2 | care, standard fertility preservation services, and fertility treatment and would require coverage for |
3 | any medically necessary ovulation-enhancing drugs and medical services related to prescribing and |
4 | monitoring the use of ovulation-enhancing drugs that is intended to treat infertility and establish a |
5 | pregnancy that results in a live birth. |
6 | This act would take effect on January 1, 2026. |
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LC000882 | |
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| LC000882 - Page 13 of 13 |