Sec. 3. Standards relating to benefits for treatment of infertility and prevention of iatrogenic infertility
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Part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg et seq.) is amended by inserting after section 2728 the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall ensure that such plan or coverage provides coverage for— the treatment of infertility, including nonexperimental assisted reproductive technology procedures, if such plan or coverage provides coverage for obstetrical services; and standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
In this section: the term assisted reproductive technology means treatments or procedures that involve the handling of human egg, sperm, and embryo outside of the body with the intent of facilitating a pregnancy, including in vitro fertilization, egg, embryo, or sperm cryopreservation, egg or embryo donation, and gestational surrogacy; the term infertility means a disease, characterized by the failure to establish a clinical pregnancy— after 12 months of regular, unprotected sexual intercourse; or due to a person's incapacity for reproduction either as an individual or with his or her partner, which may be determined after a period of less than 12 months of regular, unprotected sexual intercourse, or based on medical, sexual and reproductive history, age, physical findings, or diagnostic testing; and the term iatrogenic infertility means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
Subject to paragraph (3), a group health plan and a health insurance issuer offering group or individual health insurance coverage that includes coverage for obstetrical services shall provide coverage for treatment of infertility determined appropriate by the treating physician, including, as appropriate, ovulation induction, egg retrieval, sperm retrieval, artificial insemination, in vitro fertilization, genetic screening, intracytoplasmic sperm injection, and any other non-experimental treatment, as determined by the Secretary in consultation with appropriate professional and patient organizations such as the American Society for Reproductive Medicine, RESOLVE:
The National Infertility Association, and the American College of Obstetricians and Gynecologists. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage of fertility preservation services for individuals who undergo medically necessary treatment that may cause iatrogenic infertility, as determined by the treating physician, including cryopreservation of gametes and other procedures, as determined by the Secretary, consistent with established medical practices and professional guidelines published by professional medical organizations, including the American Society of Clinical Oncology and the American Society for Reproductive Medicine.
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for assisted reproductive technology as required under paragraph
(1)if— the individual is unable to bring a pregnancy to a live birth through minimally invasive infertility treatments, as determined appropriate by the treating physician, with consideration given to participant's or beneficiary's specific diagnoses or condition for which coverage is available under the plan or coverage; and the treatment is performed at a medical facility that— conforms to the standards of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology; and is in compliance with any standards set by an appropriate Federal agency. Cost-sharing, including deductibles and coinsurance, or other limitations for infertility and services to prevent iatrogenic infertility may not be imposed with respect to the services required to be covered under subsection
(c)to the extent that such cost-sharing exceeds the cost-sharing applied to similar services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such similar services. A group health plan and a health insurance issuer offering group or individual health insurance coverage may not— provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to be provided infertility treatments or fertility preservation services to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries; prohibit a provider from discussing with a participant or beneficiary infertility treatments or fertility preservation technology or medical treatment options relating to this section; or penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility treatments or fertility preservation services to a qualified participant or beneficiary in accordance with this section. Nothing in this section shall be construed to require a participant or beneficiary to undergo infertility treatments or fertility preservation services. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the Secretary. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted— in the next mailing made by the plan or issuer to the participant or beneficiary; as part of any yearly informational packet sent to the participant or beneficiary; or not later than January 1, 2020, whichever is earlier. Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. . Section 2724(c) of the Public Health Service Act ( 42 U.S.C. 300gg–23(c) ) is amended by striking section 2704 and inserting sections 2704 and 2708 . The amendments made by subsections
(a)and
(b)shall apply for plan years beginning on or after the date that is 6 months after the date of enactment of this Act. In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of enactment of this Act, the amendments made by subsection
(a)shall not apply to plan years beginning before the later of— the date on which the last collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of enactment of this Act), or the date occurring 6 months after the date of the enactment of this Act. For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by subsection
(a)shall not be treated as a termination of such collective bargaining agreement.
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- 42 USC 300gg–23(c)
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Sec. 3
Standards relating to benefits for treatment of infertility and prevention of iatrogenic infertility
Cite42 USC 300gg–23(c)
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