2026 -- S 2460

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LC004606

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Mack, Murray, DiMario, Valverde, Lauria, Kallman, Lawson,
Vargas, Gu, and Euer

     Date Introduced: February 06, 2026

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

one year.

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

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

     (c) For the purposes of this section, the following terms shall have the following meanings:

     (1) “Infertility” means:

     (i) The presence of a condition recognized by a healthcare provider that impacts an

individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an

individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or

any combination of those factors. This condition includes infertility arising from a disability or

medical treatments or conditions associated with a disability;

     (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth

after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s

partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the

twelve (12) month time period;

     (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected

sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual

and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss

does not restart the twelve (12) month time period;

     (iv) An individual’s inability to establish a pregnancy because the individual or the

individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;

     (v) An individual’s increased risk, independently or with the individual’s partner, of

transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or

     (vi) As defined by the American Society of Reproductive Medicine.

     (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard

fertility-preservation services" means procedures, counseling, products, medications, genetic

testing, and services intended to preserve fertility consistent with established medical practices and

professional guidelines published by the American Society for Reproductive Medicine or, the

American Society of Clinical Oncology, or other reputable professional medical organizations, for

an individual who has a medical or genetic condition, including conditions related to a disability or

chronic illness, or who is expected to undergo treatment that has a possible side effect of or may

directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the

procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.

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

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

processes.

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

LC004606 - Page 2 of 14

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

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

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

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

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

thousand dollars ($100,000).

     (d) Coverage for the treatment of infertility under this section shall be provided without

discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender

identity, genetic information, marital status, national origin, race, religion, sex, or sexual

orientation.

     (e) Coverage for the treatment of infertility under this section shall include, but shall not

be limited to:

     (1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those

     oocyte retrievals or from any oocyte retrieval;

     (2) The medical costs related to an embryo transfer to be made from or on behalf of an

insured to a third party;

     (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo

will be transferred to a surrogate; and

     (4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,

but not limited to, preimplantation genetic testing.

     (f) An insurer described in subsection (a) of this section shall not impose any of the

following:

     (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any

other limitations on coverage for the diagnosis and treatment of infertility, including the

prescription of fertility medications, different from those imposed on benefits for services not

related to infertility;

     (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage

for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of

infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for

required benefits;

     (3) Limitations on coverage based solely on arbitrary factors, including number of

attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements

on, a class protected under § 23-17-19.1, than that provided to other insureds;

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

LC004606 - Page 3 of 14

use of donor gametes, donor embryos or surrogacy;

     (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that

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

     (6) Limitations under the policy based on anything other than the medical assessment of

an individual’s licensed healthcare provider.

     (g) An insurer described in subsection (a) of this section shall provide coverage under this

section regardless of whether the insured foregoes a particular fertility treatment or procedure, if

the insured’s healthcare provider determines that the treatment or procedure is likely to be

unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.

     (h) This section does not interfere with the clinical judgment of a healthcare provider. Any

clinical guidelines used for a policy subject to the requirements of this section shall be based on

current guidelines developed by the American Society for Reproductive Medicine or the American

Society of Clinical Oncology.

     SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-23. Coverage for infertility.

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

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

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

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

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

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

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

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

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

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

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

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

treatment of infertility.

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

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

one year.

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

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

LC004606 - Page 4 of 14

     (c) For the purposes of this section, the following terms shall have the following meanings:

     (1) “Infertility” means:

     (i) The presence of a condition recognized by a healthcare provider that impacts an

individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an

individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or

any combination of those factors. This condition includes infertility arising from a disability or

medical treatments or conditions associated with a disability;

     (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth

after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s

partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the

twelve (12) month time period;

     (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected

sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual

and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss

does not restart the twelve (12) month time period;

     (iv) An individual’s inability to establish a pregnancy because the individual or the

individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;

     (v) An individual’s increased risk, independently or with the individual’s partner, of

transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or

     (vi) As defined by the American Society of Reproductive Medicine.

     (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard

fertility-preservation services" means procedures, counseling, products, medications, genetic

testing, and services intended to preserve fertility consistent with established medical practices and

professional guidelines published by the American Society for Reproductive Medicine, the

American Society of Clinical Oncology, or other reputable professional medical organizations, for

an individual who has a medical or genetic condition, including conditions related to a disability or

chronic illness, or who is expected to undergo treatment that has a possible side effect of or may

directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the

procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.

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

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

processes.

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

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

LC004606 - Page 5 of 14

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

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

thousand dollars ($100,000).

     (d) Coverage for the treatment of infertility under this section shall be provided without

discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender

identity, genetic information, marital status, national origin, race, religion, sex, or sexual

orientation.

     (e) Coverage for the treatment of infertility under this section shall include, but shall not

be limited to:

     (1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those

     oocyte retrievals or from any oocyte retrieval;

     (2) The medical costs related to an embryo transfer to be made from or on behalf of an

insured to a third party;

     (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo

will be transferred to a surrogate; and

     (4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,

but not limited, to preimplantation genetic testing.

     (f) An insurer described in subsection (a) of this section shall not impose any of the

following:

     (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any

other limitations on coverage for the diagnosis and treatment of infertility, including the

prescription of fertility medications, different from those imposed on benefits for services not

related to infertility;

     (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage

for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of

infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for

required benefits;

     (3) Limitations on coverage based solely on arbitrary factors, including number of

attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements

on, a class protected under § 23-17-19.1, than that provided to other insureds;

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

use of donor gametes, donor embryos or surrogacy;

     (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that

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

LC004606 - Page 6 of 14

     (6) Limitations under the policy based on anything other than the medical assessment of

an individual’s licensed healthcare provider.

     (g) An insurer described in subsection (a) of this section shall provide coverage under this

section regardless of whether the insured foregoes a particular fertility treatment or procedure, if

the insured’s healthcare provider determines that the treatment or procedure is likely to be

unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.

     (h) This section does not interfere with the clinical judgment of a healthcare provider. Any

clinical guidelines used for a policy subject to the requirements of this section shall be based on

current guidelines developed by the American Society for Reproductive Medicine or the American

Society of Clinical Oncology.

     SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-20. Coverage for infertility.

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

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

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

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

the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation

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

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

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

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

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

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

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

treatment of infertility.

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

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

one year.

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

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

     (c) For the purposes of this section, the following terms shall have the following meanings:

     (1) “Infertility” means:

     (i) The presence of a condition recognized by a healthcare provider that impacts an

LC004606 - Page 7 of 14

individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an

individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or

any combination of those factors. This condition includes infertility arising from a disability or

medical treatments or conditions associated with a disability;

     (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth

after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s

partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the

twelve (12) month time period;

     (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected

sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual

and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss

does not restart the twelve (12) month time period;

     (iv) An individual’s inability to establish a pregnancy because the individual or the

individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;

     (v) An individual’s increased risk, independently or with the individual’s partner, of

transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or

     (vi) As defined by the American Society of Reproductive Medicine.

     (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard

fertility-preservation services" means procedures, counseling, products, medications, genetic

testing, and services intended to preserve fertility consistent with established medical practices and

professional guidelines published by the American Society for Reproductive Medicine, the

American Society of Clinical Oncology, or other reputable professional medical organizations, for

an individual who has a medical or genetic condition, including conditions related to a disability or

chronic illness, or who is expected to undergo treatment that has a possible side effect of or may

directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the

procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.

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

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

processes.

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

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

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

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

thousand dollars ($100,000).

LC004606 - Page 8 of 14

     (d) Coverage for the treatment of infertility under this section shall be provided without

discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender

identity, genetic information, marital status, national origin, race, religion, sex, or sexual

orientation.

     (e) Coverage for the treatment of infertility under this section shall include, but shall not

be limited to:

     (1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those

     oocyte retrievals or from any oocyte retrieval;

     (2) The medical costs related to an embryo transfer to be made from or on behalf of an

insured to a third party;

     (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo

will be transferred to a surrogate; and

     (4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,

but not limited to, preimplantation genetic testing.

     (f) An insurer described in subsection (a) of this section shall not impose any of the

following:

     (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any

other limitations on coverage for the diagnosis and treatment of infertility, including the

prescription of fertility medications, different from those imposed on benefits for services not

related to infertility;

     (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage

for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of

infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for

required benefits;

     (3) Limitations on coverage based solely on arbitrary factors, including number of

attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements

on, a class protected under § 23-17-19.1, than that provided to other insureds;

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

use of donor gametes, donor embryos or surrogacy;

     (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that

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

     (6) Limitations under the policy based on anything other than the medical assessment of

an individual’s licensed healthcare provider.

     (g) An insurer described in subsection (a) of this section shall provide coverage under this

LC004606 - Page 9 of 14

section regardless of whether the insured foregoes a particular fertility treatment or procedure, if

the insured’s healthcare provider determines that the treatment or procedure is likely to be

unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.

     (h) This section does not interfere with the clinical judgment of a healthcare provider. Any

clinical guidelines used for a policy subject to the requirements of this section shall be based on

current guidelines developed by the American Society for Reproductive Medicine or the American

Society of Clinical Oncology.

     SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-33. Coverage for infertility.

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

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

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

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

between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation

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

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

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

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

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

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

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

treatment of infertility.

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

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

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

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

     (c) For the purposes of this section, the following terms shall have the following meanings:

     (1) “Infertility” means:

     (i) The presence of a condition recognized by a healthcare provider that impacts an

individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an

individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or

any combination of those factors. This condition includes infertility arising from a disability or

medical treatments or conditions associated with a disability;

LC004606 - Page 10 of 14

     (ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth

after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s

partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the

twelve (12) month time period;

     (iii) An individual's inability to establish a pregnancy after six (6) months of unprotected

sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual

and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss

does not restart the twelve (12) month time period;

     (iv) An individual’s inability to establish a pregnancy because the individual or the

individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;

     (v) An individual’s increased risk, independently or with the individual’s partner, of

transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or

     (vi) As defined by the American Society of Reproductive Medicine.

     (c) For purposes of this section, “standard fertility-preservation services” (2) "Standard

fertility-preservation services" means procedures, counseling, products, medications, genetic

testing, and services intended to preserve fertility consistent with established medical practices and

professional guidelines published by the American Society for Reproductive Medicine, the

American Society of Clinical Oncology, or other reputable professional medical organizations, for

an individual who has a medical or genetic condition, including conditions related to a disability or

chronic illness, or who is expected to undergo treatment that has a possible side effect of or may

directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the

procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.

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

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

processes.

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

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

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

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

thousand dollars ($100,000).

     (d) Coverage for the treatment of infertility under this section shall be provided without

discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender

identity, genetic information, marital status, national origin, race, religion, sex, or sexual

orientation.

LC004606 - Page 11 of 14

     (e) Coverage for the treatment of infertility under this section shall include, but shall not

be limited to:

     (1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those

     oocyte retrievals or from any oocyte retrieval;

     (2) The medical costs related to an embryo transfer to be made from or on behalf of an

insured to a third party;

     (3) Coverage regardless of whether donor gametes or embryos are used or if an embryo

will be transferred to a surrogate; and

     (4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,

but not limited to, preimplantation genetic testing.

     (f) An insurer described in subsection (a) of this section shall not impose any of the

following:

     (1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any

other limitations on coverage for the diagnosis and treatment of infertility, including the

prescription of fertility medications, different from those imposed on benefits for services not

related to infertility;

     (2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage

for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of

infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for

required benefits;

     (3) Limitations on coverage based solely on arbitrary factors, including number of

attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements

on, a class protected under § 23-17-19.1, than that provided to other insureds;

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

use of donor gametes, donor embryos or surrogacy;

     (5) Exclusions, limitations, or other restrictions on coverage of fertility medications that

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

     (6) Limitations under the policy based on anything other than the medical assessment of

an individual’s licensed healthcare provider.

     (g) An insurer described in subsection (a) of this section shall provide coverage under this

section regardless of whether the insured foregoes a particular fertility treatment or procedure, if

the insured’s healthcare provider determines that the treatment or procedure is likely to be

unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.

     (h) This section does not interfere with the clinical judgment of a healthcare provider. Any

LC004606 - Page 12 of 14

clinical guidelines used for a policy subject to the requirements of this section shall be based on

current guidelines developed by the American Society for Reproductive Medicine or the American

Society of Clinical Oncology.

     SECTION 5. This act shall take effect on January 1, 2027.

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LC004606

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would amend the current law on health insurance coverage for fertility diagnostic

care, standard fertility preservation services, and fertility treatment and would require coverage for

any medically necessary ovulation-enhancing drugs and medical services related to prescribing and

monitoring the use of ovulation-enhancing drugs that is intended to treat infertility and establish a

pregnancy that results in a live birth.

     This act would take effect on January 1, 2027.

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LC004606

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