What's happening
This bill requires insurance policies in New York to cover in vitro fertilization and fertility preservation treatments, and prohibits discrimination in such coverage.
Why it matters
Expands access to fertility care. by mandating insurance coverage for in vitro fertilization (IVF) and fertility preservation services for people at risk of medically-induced infertility (e.g., due to cancer treatment), reducing the financial barrier to these treatments.
Broadens definitions and eligibility. for infertility: The bill uses an inclusive, medical-based definition of infertility that recognizes same-sex couples, single individuals, and people of all genders, not just heterosexual couples trying to conceive.
Removes previous coverage restrictions. such as age limits and waiting periods, so that more people—including younger or older individuals and those newly insured—can access infertility treatments without delay.
Prohibits discriminatory insurance practices. , including denial of fertility coverage based on age, sex, sexual orientation, marital status, gender identity, disability, or perceived quality of life, aiming to ensure equitable access for diverse populations.
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Who cares
Headline styles
Require Fertility Insurance Coverage
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover IVF and Fertility Treatments
In Assembly Committee · Ways And Means · Sponsor Aravella Simotas
Full text
5 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
719
2019-2020 Regular Sessions
IN SENATE (Prefiled)
January 9, 2019
Introduced by Sens. SAVINO, BIAGGI -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to insurance coverage of in vitro fertilization and other fertility preservation treatments
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 13 of subsection (i) of section 3216 of the insurance law is amended by adding three new subparagraphs (C), (D) and (E) to read as follows:
(C) Every policy delivered or issued for delivery in this state that provides coverage for hospital, surgical or medical care shall provide coverage for:
(i) in vitro fertilization used in the treatment of infertility; and
(ii) standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
(D) (i) For the purposes of subparagraph (C) of this paragraph, "infertility" means a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (I) by a physician licensed to practice medicine in this state, or (II) by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse, or after six months of regular, unprotected sexual intercourse in the case of a female thirty-five years of age or older.
(ii) For the purposes of subparagraph (C) of this paragraph, "iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.
(E) No insurer providing coverage under this paragraph shall discriminate based on a covered individual's expected length of life, present or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01402-02-9
S. 719 2
predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, marital status or gender identity.
§ 2. Paragraph 6 of subsection (k) of section 3221 of the insurance law is amended by adding three new subparagraphs (E), (F) and (G) to read as follows:
(E) Every group policy delivered or issued for delivery in this state that provides hospital, surgical or medical coverage shall provide coverage for:
(i) in vitro fertilization used in the treatment of infertility; and
(ii) standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
(F) (i) For the purposes of subparagraph (E) of this paragraph, "infertility" means a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (I) by a physician licensed to practice medicine in this state, or (II) by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse, or after six months of regular, unprotected sexual intercourse in the case of a female thirty-five years of age or older.
(ii) For the purposes of subparagraph (E) of this paragraph, "iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.
(G) No insurer providing coverage under this paragraph shall discriminate based on a covered individual's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, marital status or gender identity.
§ 3. Subsection (s) of section 4303 of the insurance law, as amended by section 2 of part K of chapter 82 of the laws of 2002, is amended by adding three new paragraphs (5), (6) and (7) to read as follows:
(5) Every contract issued by a medical expense indemnity corporation, hospital service corporation or health service corporation for delivery in this state that provides hospital, surgical or medical coverage shall provide coverage for:
(A) in vitro fertilization used in the treatment of infertility; and
(B) standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
(6) (A) For the purposes of paragraph five of this subsection, "infertility" means a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (i) by a physician licensed to practice medicine in this state, or (ii) by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse, or after six months of regular, unprotected sexual intercourse in the case of a female thirty-five years of age or older.
(B) For the purposes of paragraph five of this subsection, "iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.
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(7) No medical expense indemnity corporation, hospital service corporation or health service corporation providing coverage under this subsection shall discriminate based on a covered individual's expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, marital status or gender identity.
§ 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221 of the insurance law, as amended by section 1 of part K of chapter 82 of the laws of 2002, is amended to read as follows:
(C) Coverage of diagnostic and treatment procedures, including prescription drugs, used in the diagnosis and treatment of infertility as required by subparagraphs (A) and (B) of this paragraph shall be provided in accordance with the provisions of this subparagraph.
(i) [Coverage shall be provided for persons whose ages range from twenty-one through forty-four years, provided that nothing herein shall preclude the provision of coverage to persons whose age is below or above such range.
(ii)] Diagnosis and treatment of infertility shall be prescribed as part of a physician's overall plan of care and consistent with the guidelines for coverage as referenced in this subparagraph.
[(iii)] (ii) Coverage may be subject to co-payments, coinsurance and deductibles as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within a given policy.
[(iv) Coverage shall be limited to those individuals who have been previously covered under the policy for a period of not less than twelve months, provided that for the purposes of this subparagraph "period of not less than twelve months" shall be determined by calculating such time from either the date the insured was first covered under the existing policy or from the date the insured was first covered by a previously in-force converted policy, whichever is earlier.
(v)] (iii) Coverage shall not be required to include the diagnosis and treatment of infertility in connection with: (I) [in vitro fertilization, gamete intrafallopian tube transfers or zygote intrafallopian tube transfers; (II)] the reversal of elective sterilizations; [(III)] (II) sex change procedures; [(IV)] (III) cloning; or [(V)] (IV) medical or surgical services or procedures that are deemed to be experimental in accordance with clinical guidelines referenced in clause [(vi)] (iv) of this subparagraph.
[(vi)] (iv) The superintendent, in consultation with the commissioner of health, shall promulgate regulations which shall stipulate the guidelines and standards which shall be used in carrying out the provisions of this subparagraph, which shall include:
(I) [The determination of "infertility" in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine;
(II)] The identification of experimental procedures and treatments not covered for the diagnosis and treatment of infertility determined in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine;
[(III)] (II) The identification of the required training, experience and other standards for health care providers for the provision of procedures and treatments for the diagnosis and treatment of infertility
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determined in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine; and
[(IV)] (III) The determination of appropriate medical candidates by the treating physician in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and/or the American Society for Reproductive Medicine.
§ 5. Paragraph 3 of subsection (s) of section 4303 of the insurance law, as amended by section 2 of part K of chapter 82 of the laws of 2002, is amended to read as follows:
(3) Coverage of diagnostic and treatment procedures, including prescription drugs used in the diagnosis and treatment of infertility as required by paragraphs one and two of this subsection shall be provided in accordance with this paragraph.
(A) [Coverage shall be provided for persons whose ages range from twenty-one through forty-four years, provided that nothing herein shall preclude the provision of coverage to persons whose age is below or above such range.
(B)] Diagnosis and treatment of infertility shall be prescribed as part of a physician's overall plan of care and consistent with the guidelines for coverage as referenced in this paragraph.
[(C)] (B) Coverage may be subject to co-payments, coinsurance and deductibles as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within a given policy.
[(D) Coverage shall be limited to those individuals who have been previously covered under the policy for a period of not less than twelve months, provided that for the purposes of this paragraph "period of not less than twelve months" shall be determined by calculating such time from either the date the insured was first covered under the existing policy or from the date the insured was first covered by a previously in-force converted policy, whichever is earlier.
(E)] (C) Coverage shall not be required to include the diagnosis and treatment of infertility in connection with: (i) [in vitro fertilization, gamete intrafallopian tube transfers or zygote intrafallopian tube transfers; (ii)] the reversal of elective sterilizations; [(iii)] (ii) sex change procedures; [(iv)] (iii) cloning; or [(v)] (iv) medical or surgical services or procedures that are deemed to be experimental in accordance with clinical guidelines referenced in subparagraph [(F)] (D) of this paragraph.
[(F)] (D) The superintendent, in consultation with the commissioner of health, shall promulgate regulations which shall stipulate the guidelines and standards which shall be used in carrying out the provisions of this paragraph, which shall include:
(i) [The determination of "infertility" in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine;
(ii)] The identification of experimental procedures and treatments not covered for the diagnosis and treatment of infertility determined in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine;
[(iii)] (ii) The identification of the required training, experience and other standards for health care providers for the provision of procedures and treatments for the diagnosis and treatment of infertility
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determined in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine; and
[(iv)] (iii) The determination of appropriate medical candidates by the treating physician in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and/or the American Society for Reproductive Medicine.
§ 6. This act shall take effect on the first day of January next succeeding the date on which it shall have become a law and shall apply to all policies issued, renewed, altered or modified on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to insurance coverage of in vitro fertilization and other fertility preser- vation treatments
Purpose
To require health insurance policies to provide coverage for in-vitro fertilization
Summary of provisions
Sections one of the bill amends section 3216 of the Ins. L. to require that individual policies provide coverage for (1) in-vitro fertilization used in the treatment of infertility, and (2) fertility preservation services, regardless of length or quality of life, medical dependency, disability, or personal characteristics.
Read the full memo (757 words)
Section two of the bill would amend section 3221 of the Ins. L. to require that group policies provide coverage for (1) in-vitro fertiliza- tion used in the treatment of infertility, and (2) fertility preserva- tion services, regardless of length or quality of life, medical depend- ency, disability, or personal characteristics.
Section three of the bill would amend Section 4303 of the Ins. L. to require that policies issued by a medical expense indemnity corporation, hospital service corporation, or health service corporation provide coverage for (1) in-vitro fertilization used in the treatment of infer- tility, and (2) fertility preservation services, regardless of length or quality of life, medical dependency, disability, or personal character- istics.
Section four of the bill amends subparagraph c of paragraph 6 of subsection k of section 3221 of the insurance law to repeal discrimina- tory age restrictions and provisions exempting in-vitro fertilization, gamete intrafallopian tube transfers or zygote intrafallopian tube transfers from coverage requirements for group or blanket accident and health insurance plans.
Section five of the bill amends paragraph 3 of subsection S of section 4303 of the insurance law to apply the same requirements to benefits provided by a medical expense indemnity corporation, hospital service corporation, or health service corporation.
Section six of the bill provides the effective date of the bill.
Existing law
Currently, New York requires coverage of some infertility treatments in the commercial market place for women between the ages of 21 and 44, However, current law does not require coverage for in-vitro fertilize- tion (IVF), or fertility preservation.
Justification
It is estimated that one in eight individuals or couples have trouble getting pregnant or sustaining pregnancy. While family building options do exist for people affected by infertility, these options are often cost-prohibitive, with 671 of individuals or couples reporting spending at least $10,000. High costs present a major bather to medical treat- ment; nearly half of all individuals affected by infertility lack insur- ance coverage necessary for fertility treatment.
The rapid advancement of medical technology in the past 20 years estab- lished in-vitro fertilization as the safest and most effective form of fertility treatment. Compared to treatments presently covered under New York state law, such as ovulation induction or ovulation enhancement, in-vitro fertilization results in fewer pregnancy complications and high-risk births. Several states, including Massachusetts, Rhode Island, New Jersey, Maryland, Illinois, Arkansas, Hawaii, and Connecticut, have already enacted laws requiring insurers to cover in-vitro fertilization. These states experience lower rates of multiple births and associated neo-natal and pediatric care costs. This legislation has the potential to save New York millions of dollars in long-term health care costs, since patients would no longer be forced to rely on higher risk medical procedures.
Under current law, New York requires insurers to provide coverage for some diagnostic and treatment procedures for infertility. However, these requirements do not extend to in-vitro fertilization. This bill would update the existing law to reflect advances in modern medical technolo- gy, requiring coverage for in-vitro fertilization to expand access to this procedure and enable patients and their physicians to choose the best course of treatment for infertility. It would also provide a clear definition of infertility and ensure that cancer patients whose ability to conceive has been compromised by chemotherapy, radiation, surgery, or other medical procedures have fair access to fertility preservation methods. Lastly, this bill includes anti-discrimination protections for patients eligible for in-vitro fertilization, as required by the Afford- able Care Act.
Legislative history
2018 Session- S.3148 - referred to Insurance, same as bill passed Assem- bly 2017 Session- S.3148 - referred to Insurance, same as bill passed Assem- bly 2016 Session- S.7219 referred to Insurance; same as bill reported from Assembly Insurance and Codes, died in Rules.
Fiscal implications
None.
Effective date
This act would take effect on the first day of January next succeeding the date on which it shall have become a law and shall apply to all policies issued, renewed, altered or modified on or after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.