Sec. 2. Standards relating to benefits for fertility treatment

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Part D of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–111 et seq. ) is amended by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for fertility treatment, if such plan or coverage provides coverage for obstetrical services. In this section, the term fertility treatment includes the following: Preservation of human oocytes, sperm, or embryos. Artificial insemination, including intravaginal insemination, intracervical insemination, and intrauterine insemination.

Assisted reproductive technology, including in vitro fertilization and other treatments or procedures in which reproductive genetic material, such as oocytes, sperm, and embryos, are handled, when clinically appropriate. Genetic testing of embryos. Medications prescribed or obtained over-the-counter, as indicated for fertility. Gamete donation. Such other information, referrals, treatments, procedures, medications, laboratory testing, technologies, and services relating to fertility as the Secretary determines appropriate.

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 fertility treatment determined appropriate by the health care provider, regardless of whether the participant, beneficiary, or enrollee receiving such treatment has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the treatment is performed at, or prescribed by, a medical facility that is in compliance with relevant standards set by an appropriate Federal agency.

Cost-sharing, including deductibles and coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to fertility treatment. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. 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, beneficiary, or enrollee to encourage such participant, beneficiary, or enrollee not to seek or obtain fertility treatment to which such participant, beneficiary, or enrollee is entitled under this section or to providers to induce such providers not to provide medically appropriate fertility treatments to participants, beneficiaries, or enrollees; prohibit a provider from discussing with a participant, beneficiary, or enrollee fertility treatment relating to this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided fertility treatment to a qualified participant, beneficiary, or enrollee in accordance with this section; or on the ground prohibited under title VI of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, section 504 of the Rehabilitation Act of 1973, or section 1557 of the Patient Protection and Affordable Care Act, exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. Nothing in this section shall be construed to require a participant, beneficiary, or enrollee to undergo fertility treatment. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide notice to each participant, beneficiary, and enrollee under such plan or coverage 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— not later than the earlier of— in the first standard mailing made by the plan or issuer to the participant, beneficiary, or enrollee following the effective date of such regulations; as part of any yearly informational packet sent to the participant, beneficiary, or enrollee; or January 1, 2027; in the case of a participant, beneficiary, or enrollee not enrolled in the plan or coverage on the date of transmission under paragraph (1), upon initial enrollment of such participant, beneficiary, or enrollee; and on an annual basis after the transmission under paragraph

(1)or (2). 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. . Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185 et seq. ) is amended by adding at the end the following: A group health plan or a health insurance issuer offering group health insurance coverage shall provide coverage for fertility treatment, if such plan or coverage provides coverage for obstetrical services. In this section, the term fertility treatment includes the following: Preservation of human oocytes, sperm, or embryos. Artificial insemination, including intravaginal insemination, intracervical insemination, and intrauterine insemination. Assisted reproductive technology, including in vitro fertilization and other treatments or procedures in which reproductive genetic material, such as oocytes, sperm, and embryos, are handled, when clinically appropriate. Genetic testing of embryos. Medications prescribed or obtained over-the-counter, as indicated for fertility. Gamete donation. Such other information, referrals, treatments, procedures, medications, laboratory testing, technologies, and services relating to fertility as the Secretary of Health and Human Services determines appropriate. A group health plan and a health insurance issuer offering group health insurance coverage that includes coverage for obstetrical services shall provide coverage for fertility treatment determined appropriate by the health care provider, regardless of whether the participant or beneficiary receiving such treatment has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the treatment is performed at, or prescribed by, a medical facility that is in compliance with relevant standards set by an appropriate Federal agency. Cost-sharing, including deductibles and coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to fertility treatment. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. A group health plan and a health insurance issuer offering group health insurance coverage may not— provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to seek or obtain fertility treatment to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide medically appropriate fertility treatments to participants or beneficiaries; prohibit a provider from discussing with a participant or beneficiary fertility treatment relating to this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided fertility treatment to a qualified participant or beneficiary in accordance with this section; or on the ground prohibited under title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq. ), title IX of the Education Amendments of 1972 ( 20 U.S.C. 1681 et seq. ), the Age Discrimination Act of 1975 ( 42 U.S.C. 6101 et seq. ), section 504 of the Rehabilitation Act of 1973 ( 29 U.S.C. 794 ), or section 1557 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18116 ), exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. Nothing in this section shall be construed to require a participant or beneficiary to undergo fertility treatment. A group health plan and a health insurance issuer offering group health insurance coverage shall provide notice to each participant and beneficiary under such plan or coverage 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— not later than the earlier of— in the first standard mailing made by the plan or issuer to the participant or beneficiary following the effective date of such regulations; as part of any yearly informational packet sent to the participant or beneficiary; or January 1, 2027; in the case of a participant or beneficiary not enrolled in the plan or coverage on the date of transmission under paragraph (1), upon initial enrollment of such participant or beneficiary; and on an annual basis after the transmission under paragraph

(1)or (2). Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. . The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1001 et seq. ) is amended by inserting after the item relating to section 725 the following new item: Sec. 726. Standards relating to benefits for fertility treatment. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: A group health plan shall provide coverage for fertility treatment, if such plan provides coverage for obstetrical services. In this section, the term fertility treatment includes the following: Preservation of human oocytes, sperm, or embryos. Artificial insemination, including intravaginal insemination, intracervical insemination, and intrauterine insemination. Assisted reproductive technology, including in vitro fertilization and other treatments or procedures in which reproductive genetic material, such as oocytes, sperm, and embryos, are handled, when clinically appropriate. Genetic testing of embryos. Medications prescribed or obtained over-the-counter, as indicated for fertility. Gamete donation. Such other information, referrals, treatments, procedures, medications, laboratory testing, technologies, and services relating to fertility as the Secretary of Health and Human Services determines appropriate. A group health plan that includes coverage for obstetrical services shall provide coverage for fertility treatment determined appropriate by the health care provider, regardless of whether the participant or beneficiary receiving such treatment has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the treatment is performed at, or prescribed by, a medical facility that is in compliance with relevant standards set by an appropriate Federal agency. Cost-sharing, including deductibles and coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to fertility treatment. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. A group health plan may not— provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to seek or obtain fertility treatment to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide medically appropriate fertility treatments to participants or beneficiaries; prohibit a provider from discussing with a participant or beneficiary fertility treatment relating to this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided fertility treatment to a qualified participant or beneficiary in accordance with this section; or on the ground prohibited under title VI of the Civil Rights Act of 1964 ( 42 U.S.C. 2000d et seq. ), title IX of the Education Amendments of 1972 ( 20 U.S.C. 1681 et seq. ), the Age Discrimination Act of 1975 ( 42 U.S.C. 6101 et seq. ), section 504 of the Rehabilitation Act of 1973 ( 29 U.S.C. 794 ), or section 1557 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18116 ), exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. Nothing in this section shall be construed to require a participant or beneficiary to undergo fertility treatment. A group health plan 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 and shall be transmitted— not later than the earlier of— in the first standard mailing made by the plan to the participant or beneficiary following the effective date of such regulations; as part of any yearly informational packet sent to the participant or beneficiary; or January 1, 2027; in the case of a participant or beneficiary not enrolled in the plan on the date of transmission under paragraph (1), upon initial enrollment of such participant or beneficiary; and on an annual basis after the transmission under paragraph

(1)or (2). Nothing in this section shall be construed to prevent a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. . The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9826. Standards relating to benefits for fertility treatment. . 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 2799A–11 . Section 731(c) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1191(c) ) is amended by striking section 711 and inserting sections 711 and 726 . 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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