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,
Cruz, Diaz, and Fogarty

     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.

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     SECTION 5. This act shall take effect on January 1, 2026.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND INSURANCE POLICIES

***

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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