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,
DiMario, and Bissaillon

     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.

========

LC001630

========

 

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

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pregnancy-related benefits to cover medically necessary expenses for diagnosis and treatment of

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infertility and standard fertility-preservation services regardless of the insured’s age. This act would

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also change the definitions of infertility and standard fertility-preservation services as they

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currently exist in chapters 27-18, 27-19, 27-20 and 27-41. The act would further remove the one

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hundred thousand dollar ($100,000) lifetime cap on coverage for these services.

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     This act would apply to health plans that are entered into, amended, extended, or renewed

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on or after January 1, 2026.

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LC001630

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LC001630 - Page 13 of 13