2025 -- S 0691 | |
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LC001630 | |
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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 SICKNESS INSURANCE POLICIES | |
| |
Introduced By: Senators Mack, Valverde, Urso, Murray, Lauria, Ujifusa, Kallman, Euer, | |
Date Introduced: March 07, 2025 | |
Referred To: Senate 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 | (1) The presence of a condition recognized by a healthcare provider as a cause of loss or |
| |
1 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
2 | physical findings, diagnostic testing, or any combination of those factors; |
3 | (2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
4 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
5 | partner have the necessary gametes to achieve pregnancy; |
6 | (3) An individual’s inability to establish pregnancy after six (6) months of unprotected |
7 | sexual intercourse due to the individual’s age when the individual and the individual’s partner have |
8 | the necessary gametes to achieve pregnancy; |
9 | (4) An individual’s inability to achieve pregnancy as an individual or with a partner |
10 | because the individual or the individual and the individual’s partner do not have the necessary |
11 | gametes to achieve a pregnancy; |
12 | (5) An individual’s increased risk, independently or with the individual’s partner, of |
13 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and |
14 | (6) Infertility as defined by the American Society of Reproductive Medicine, its successor |
15 | organization, or a comparable organization. |
16 | (c) For purposes of this section, “standard fertility-preservation services” means |
17 | procedures consistent with established medical practices and professional guidelines published by |
18 | the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or |
19 | other reputable professional medical organizations, its successor organization, or a comparable |
20 | organization, for an individual who has a medical or genetic condition or who is expected to |
21 | undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of |
22 | impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and |
23 | storage of gametes, embryos, and reproductive material. |
24 | (d) For purposes of this section, pregnancy resulting in a loss does not cause the time period |
25 | of trying to achieve a pregnancy to be restarted. |
26 | (e) Coverage for the treatment of infertility under this section shall be provided without |
27 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
28 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
29 | or sexual orientation. |
30 | (f) Coverage for the treatment of infertility under this section shall: |
31 | (1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers |
32 | from those oocyte retrievals or from any oocyte retrieval; |
33 | (2) Include the medical costs related to an embryo transfer to be made from or on behalf of |
34 | an insured to a third party; and |
| LC001630 - Page 2 of 13 |
1 | (3) Be provided regardless of whether donor gametes or embryos are used or if an embryo |
2 | will be transferred to a surrogate. |
3 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
4 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
5 | processes. |
6 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
7 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
8 | the American Society of Clinical Oncology, or other reputable professional organizations. |
9 | (f)(g) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, |
10 | this section shall apply to blanket or group policies of insurance. |
11 | (g) The health insurance contract may limit coverage to a lifetime cap of one hundred |
12 | thousand dollars ($100,000). |
13 | (h) An insurer described in subsection (a) of this section shall not impose any of the |
14 | following: |
15 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
16 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
17 | prescription of fertility medications, different from those imposed on benefits for services not |
18 | related to infertility. |
19 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
20 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
21 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
22 | required benefits. |
23 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
24 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
25 | upon a class protected under § 23-17-19.1 than other insureds. |
26 | (4) Limitations on coverage required under this section based on an individual's use of |
27 | donor gametes, donor embryos or surrogacy. |
28 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
29 | are different from those imposed on any other prescription medications. |
30 | (6) Limitations under the policy based on anything other than the medical assessment of |
31 | an individual’s licensed healthcare provider. |
32 | (i) An insurer described in subsection (a) of this section shall provide coverage under this |
33 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
34 | insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful |
| LC001630 - Page 3 of 13 |
1 | or the insured seeks to use previously retrieved oocytes or embryos. |
2 | (j) This section shall not interfere with the clinical judgment of a healthcare provider. Any |
3 | clinical guidelines used for a policy subject to the requirements of this section shall be based on |
4 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
5 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
6 | the American College of Obstetrics and Gynecology. |
7 | SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit |
8 | Hospital Service Corporations" is hereby amended to read as follows: |
9 | 27-19-23. Coverage for infertility. |
10 | (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for |
11 | delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare |
12 | or other governmental programs, that includes pregnancy-related benefits, shall provide coverage |
13 | for medically necessary expenses of diagnosis and treatment of infertility for women between the |
14 | ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services |
15 | when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility |
16 | to a covered person. To the extent that a nonprofit hospital service corporation provides |
17 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
18 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
19 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
20 | (25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent |
21 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
22 | treatment of infertility. |
23 | (b) For purposes of this section, “infertility” means: the condition of an otherwise |
24 | presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of |
25 | one year. |
26 | (1) The presence of a condition recognized by a healthcare provider as a cause of loss or |
27 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
28 | physical findings, diagnostic testing, or any combination of those factors; |
29 | (2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
30 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
31 | partner have the necessary gametes to achieve pregnancy; |
32 | (3) An individual’s inability to establish pregnancy after six (6) months of unprotected |
33 | sexual intercourse due to the individual’s age when the individual and the individual’s partner have |
34 | the necessary gametes to achieve pregnancy; |
| LC001630 - Page 4 of 13 |
1 | (4) An individual’s inability to achieve pregnancy as an individual or with a partner |
2 | because the individual or the individual and the individual’s partner do not have the necessary |
3 | gametes to achieve a pregnancy; |
4 | (5) An individual’s increased risk, independently or with the individual’s partner, of |
5 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and |
6 | (6) Infertility as defined by the American Society of Reproductive Medicine, its successor |
7 | organization, or a comparable organization. |
8 | (c) For purposes of this section, “standard fertility-preservation services” means |
9 | procedures consistent with established medical practices and professional guidelines published by |
10 | the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or |
11 | other reputable professional medical organizations, its successor organization, or a comparable |
12 | organization, for an individual who has a medical or genetic condition or who is expected to |
13 | undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of |
14 | impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and |
15 | storage of gametes, embryos, and reproductive material. |
16 | (d) For purposes of this section, pregnancy resulting in a loss does not cause the time period |
17 | of trying to achieve a pregnancy to be restarted. |
18 | (e) Coverage for the treatment of infertility under this section shall be provided without |
19 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
20 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
21 | or sexual orientation. |
22 | (f) Coverage for the treatment of infertility under this section shall: |
23 | (1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers |
24 | from those oocyte retrievals or from any oocyte retrieval; |
25 | (2) Include the medical costs related to an embryo transfer to be made from or on behalf of |
26 | an insured to a third party; and |
27 | (3) Be provided regardless of whether donor gametes or embryos are used or if an embryo |
28 | will be transferred to a surrogate. |
29 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
30 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
31 | processes. |
32 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
33 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
34 | the American Society of Clinical Oncology, or other reputable professional organizations. |
| LC001630 - Page 5 of 13 |
1 | (f) The health insurance contract may limit coverage to a lifetime cap of one hundred |
2 | thousand dollars ($100,000). |
3 | (g) An insurer described in subsection (a) of this section shall not impose any of the |
4 | following: |
5 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
6 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
7 | prescription of fertility medications, different from those imposed on benefits for services not |
8 | related to infertility. |
9 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
10 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
11 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
12 | required benefits. |
13 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
14 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
15 | upon a class protected under § 23-17-19.1 than other insureds. |
16 | (4) Limitations on coverage required under this section based on an individual's use of |
17 | donor gametes, donor embryos or surrogacy. |
18 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
19 | are different from those imposed on any other prescription medications. |
20 | (6) Limitations under the policy based on anything other than the medical assessment of |
21 | an individual’s licensed healthcare provider. |
22 | (h) An insurer described in subsection (a) of this section shall provide coverage under this |
23 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
24 | insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful |
25 | or the insured seeks to use previously retrieved oocytes or embryos. |
26 | (i) This section shall not interfere with the clinical judgment of a healthcare provider. Any |
27 | clinical guidelines used for a policy subject to the requirements of this section shall be based on |
28 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
29 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
30 | the American College of Obstetrics and Gynecology. |
31 | SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit |
32 | Medical Service Corporations" is hereby amended to read as follows: |
33 | 27-20-20. Coverage for infertility. |
34 | (a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for |
| LC001630 - Page 6 of 13 |
1 | delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare |
2 | or other governmental programs, that includes pregnancy-related benefits, shall provide coverage |
3 | for the medically necessary expenses of diagnosis and treatment of infertility for women between |
4 | the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services |
5 | when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility |
6 | to a covered person. To the extent that a nonprofit medical service corporation provides |
7 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
8 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
9 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
10 | (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent |
11 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
12 | treatment of infertility. |
13 | (b) For purposes of this section, “infertility” means: the condition of an otherwise |
14 | presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of |
15 | one year. |
16 | (1) The presence of a condition recognized by a healthcare provider as a cause of loss or |
17 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
18 | physical findings, diagnostic testing, or any combination of those factors; |
19 | (2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
20 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
21 | partner have the necessary gametes to achieve pregnancy; |
22 | (3) An individual’s inability to establish pregnancy after six (6) months of unprotected |
23 | sexual intercourse due to the individual’s age when the individual and the individual’s partner have |
24 | the necessary gametes to achieve pregnancy; |
25 | (4) An individual’s inability to achieve pregnancy as an individual or with a partner |
26 | because the individual or the individual and the individual’s partner do not have the necessary |
27 | gametes to achieve a pregnancy; |
28 | (5) An individual’s increased risk, independently or with the individual’s partner, of |
29 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and |
30 | (6) Infertility as defined by the American Society of Reproductive Medicine, its successor |
31 | organization, or a comparable organization. |
32 | (c) For purposes of this section, “standard fertility-preservation services” means |
33 | procedures consistent with established medical practices and professional guidelines published by |
34 | the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or |
| LC001630 - Page 7 of 13 |
1 | other reputable professional medical organizations, its successor organization, or a comparable |
2 | organization, for an individual who has a medical or genetic condition or who is expected to |
3 | undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of |
4 | impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and |
5 | storage of gametes, embryos, and reproductive material. |
6 | (d) For purposes of this section, pregnancy resulting in a loss does not cause the time period |
7 | of trying to achieve a pregnancy to be restarted. |
8 | (e) Coverage for the treatment of infertility under this section shall be provided without |
9 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
10 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
11 | or sexual orientation. |
12 | (f) Coverage for the treatment of infertility under this section shall: |
13 | (1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers |
14 | from those oocyte retrievals or from any oocyte retrieval; |
15 | (2) Include the medical costs related to an embryo transfer to be made from or on behalf of |
16 | an insured to a third party; and |
17 | (3) Be provided regardless of whether donor gametes or embryos are used or if an embryo |
18 | will be transferred to a surrogate. |
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 | (g) An insurer described in subsection (a) of this section shall not impose any of the |
28 | following: |
29 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
30 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
31 | prescription of fertility medications, different from those imposed on benefits for services not |
32 | related to infertility. |
33 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
34 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
| LC001630 - Page 8 of 13 |
1 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
2 | required benefits. |
3 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
4 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
5 | upon a class protected under § 23-17-19.1 than other insureds. |
6 | (4) Limitations on coverage required under this section based on an individual's use of |
7 | donor gametes, donor embryos or surrogacy. |
8 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
9 | are different from those imposed on any other prescription medications. |
10 | (6) Limitations under the policy based on anything other than the medical assessment of |
11 | an individual’s licensed healthcare provider. |
12 | (h) An insurer described in subsection (a) of this section shall provide coverage under this |
13 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
14 | insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful |
15 | or the insured seeks to use previously retrieved oocytes or embryos. |
16 | (i) This section shall not interfere with the clinical judgment of a healthcare provider. Any |
17 | clinical guidelines used for a policy subject to the requirements of this section shall be based on |
18 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
19 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
20 | the American College of Obstetrics and Gynecology. |
21 | SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health |
22 | Maintenance Organizations" is hereby amended to read as follows: |
23 | 27-41-33. Coverage for infertility. |
24 | (a) Any health maintenance organization service contract plan or policy delivered, issued |
25 | for delivery, or renewed in this state, except a contract providing supplemental coverage to |
26 | Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide |
27 | coverage for medically necessary expenses of diagnosis and treatment of infertility for women |
28 | between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation |
29 | services when a medically necessary medical treatment may directly or indirectly cause iatrogenic |
30 | infertility to a covered person. To the extent that a health maintenance organization provides |
31 | reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than |
32 | infertility, those tests and procedures shall not be excluded from reimbursement when provided |
33 | attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five |
34 | (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent |
| LC001630 - Page 9 of 13 |
1 | (20%), may be required for those programs and/or procedures the sole purpose of which is the |
2 | treatment of infertility. |
3 | (b) For purposes of this section, “infertility” means: the condition of an otherwise healthy |
4 | individual who is unable to conceive or sustain a pregnancy during a period of one year. |
5 | (1) The presence of a condition recognized by a healthcare provider as a cause of loss or |
6 | impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, |
7 | physical findings, diagnostic testing, or any combination of those factors; |
8 | (2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth |
9 | after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s |
10 | partner have the necessary gametes to achieve pregnancy; |
11 | (3) An individual’s inability to establish pregnancy after six (6) months of unprotected |
12 | sexual intercourse due to the individual’s age when the individual and the individual’s partner have |
13 | the necessary gametes to achieve pregnancy; |
14 | (4) An individual’s inability to achieve pregnancy as an individual or with a partner |
15 | because the individual or the individual and the individual’s partner do not have the necessary |
16 | gametes to achieve a pregnancy; |
17 | (5) An individual’s increased risk, independently or with the individual’s partner, of |
18 | transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and |
19 | (6) Infertility as defined by the American Society of Reproductive Medicine, its successor |
20 | organization, or a comparable organization. |
21 | (c) For purposes of this section, “standard fertility-preservation services” means |
22 | procedures consistent with established medical practices and professional guidelines published by |
23 | the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or |
24 | other reputable professional medical organizations, its successor organization, or a comparable |
25 | organization, for an individual who has a medical or genetic condition or who is expected to |
26 | undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of |
27 | impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and |
28 | storage of gametes, embryos, and reproductive material. |
29 | (d) For purposes of this section, pregnancy resulting in a loss does not cause the time period |
30 | of trying to achieve a pregnancy to be restarted. |
31 | (e) Coverage for the treatment of infertility under this section shall be provided without |
32 | discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender |
33 | expression, gender identity, genetic information, marital status, national origin, race, religion, sex, |
34 | or sexual orientation. |
| LC001630 - Page 10 of 13 |
1 | (f) Coverage for the treatment of infertility under this section shall: |
2 | (1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers |
3 | from those oocyte retrievals or from any oocyte retrieval; |
4 | (2) Include the medical costs related to an embryo transfer to be made from or on behalf of |
5 | an insured to a third party; and |
6 | (3) Be provided regardless of whether donor gametes or embryos are used or if an embryo |
7 | will be transferred to a surrogate. |
8 | (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by |
9 | surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or |
10 | processes. |
11 | (e) For purposes of this section, “may directly or indirectly cause” means treatment with a |
12 | likely side effect of infertility as established by the American Society for Reproductive Medicine, |
13 | the American Society of Clinical Oncology, or other reputable professional organizations. |
14 | (f) The health insurance contract may limit coverage to a lifetime cap of one hundred |
15 | thousand dollars ($100,000). |
16 | (g) An insurer described in subsection (a) of this section shall not impose any of the |
17 | following: |
18 | (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any |
19 | other limitations on coverage for the diagnosis and treatment of infertility, including the |
20 | prescription of fertility medications, different from those imposed on benefits for services not |
21 | related to infertility. |
22 | (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage |
23 | for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of |
24 | infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for |
25 | required benefits. |
26 | (3) Limitations on coverage based solely on arbitrary factors, including number of |
27 | attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements |
28 | upon a class protected under § 23-17-19.1 than other insureds. |
29 | (4) Limitations on coverage required under this section based on an individual's use of |
30 | donor gametes, donor embryos or surrogacy. |
31 | (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that |
32 | are different from those imposed on any other prescription medications. |
33 | (6) Limitations under the policy based on anything other than the medical assessment of |
34 | an individual’s licensed healthcare provider. |
| LC001630 - Page 11 of 13 |
1 | (h) An insurer described in subsection (a) of this section shall provide coverage under this |
2 | section regardless of whether the insured foregoes a particular fertility treatment or procedure if the |
3 | insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful |
4 | or the insured seeks to use previously retrieved oocytes or embryos. |
5 | (i) This section shall not interfere with the clinical judgment of a healthcare provider. Any |
6 | clinical guidelines used for a policy subject to the requirements of this section shall be based on |
7 | current guidelines developed by the American Society for Reproductive Medicine, its successor |
8 | organization, or a comparable organization such as the American Society of Clinical Oncology or |
9 | the American College of Obstetrics and Gynecology. |
10 | SECTION 5. This act shall apply to health plans that are entered into, amended, extended, |
11 | or renewed on or after January 1, 2026. |
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| LC001630 - Page 12 of 13 |
EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
*** | |
1 | This act would require individual and group health insurance policies that provide |
2 | pregnancy-related benefits to cover medically necessary expenses for diagnosis and treatment of |
3 | infertility and standard fertility-preservation services regardless of the insured’s age. This act would |
4 | also change the definitions of infertility and standard fertility-preservation services as they |
5 | currently exist in chapters 27-18, 27-19, 27-20 and 27-41. The act would further remove the one |
6 | hundred thousand dollar ($100,000) lifetime cap on coverage for these services. |
7 | This act would apply to health plans that are entered into, amended, extended, or renewed |
8 | on or after January 1, 2026. |
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LC001630 | |
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| LC001630 - Page 13 of 13 |