A10137 Summary:

BILL NOA10137
 
SAME ASSAME AS S07219
 
SPONSORSimotas
 
COSPNSRQuart, Bronson, Lavine, McDonald, Solages, Braunstein, Bichotte, Linares, Steck, Seawright, Giglio, Simon, Brindisi
 
MLTSPNSREnglebright
 
Add §3242, amd §§3221 & 4303, Ins L
 
Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.
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A10137 Actions:

BILL NOA10137
 
05/12/2016referred to insurance
06/14/2016reported referred to codes
06/15/2016reported referred to rules
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A10137 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          10137
 
                   IN ASSEMBLY
 
                                      May 12, 2016
                                       ___________
 
        Introduced  by M. of A. SIMOTAS -- read once and referred to the Commit-
          tee 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 Assem-
        bly, do enact as follows:

     1    Section 1. The insurance law is amended by adding a new  section  3242
     2  to read as follows:
     3    §  3242.  In  vitro  fertilization and fertility-related provisions in
     4  policies. (a) Except as provided in subsection (c) of this  section,  no
     5  policy of group or blanket accident and health insurance shall be deliv-
     6  ered  or issued for delivery in this state to a group unless it contains
     7  in substance the following provisions or provisions which in the opinion
     8  of the superintendent are more favorable to the holders of such  certif-
     9  icates  or  not  less  favorable to the holders of such certificates and
    10  more favorable to policyholders:
    11    (1)  Coverage  of  diagnostic  and  treatment  procedures,   including
    12  prescription drugs and in vitro fertilization, used in the diagnosis and
    13  treatment of infertility. As used in this section, "infertility" means a
    14  disease  characterized by the incapacity to impregnate another person or
    15  to conceive, as diagnosed (A) by a physician licensed to practice  medi-
    16  cine  in  the state, or (B) by the failure to establish a clinical preg-
    17  nancy after twelve months of regular, unprotected sexual intercourse.
    18    (2) Coverage of medically necessary expenses  for  standard  fertility
    19  preservation services when a necessary medical treatment may directly or
    20  indirectly  cause iatrogenic infertility to a covered person. As used in
    21  this section, "iatrogenic infertility" means an impairment of  fertility
    22  by surgery, radiation, chemotherapy or other medical treatment affecting
    23  reproductive organs or processes.
    24    Policies  which  cover  hospital  services  only,  medical or surgical
    25  services only, or prescription drugs only, shall  provide  fertility-re-
    26  lated coverage to the extent they fall within the categories of services
    27  otherwise covered.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14892-01-6

        A. 10137                            2
 
     1    (b) In determining coverage pursuant to this section, an insurer shall
     2  not discriminate based on an individual's expected length of life, pres-
     3  ent  or  predicted  disability, degree of medical dependency, quality of
     4  life, or other health conditions, nor based on personal characteristics,
     5  including age, sex, sexual orientation or marital status.
     6    (c) The requirements of this section shall not apply to group or blan-
     7  ket  accident  and  health  insurance policies issued in the small group
     8  market.
     9    §  2. Subparagraph (C) of paragraph 6 of  subsection  (k)  of  section
    10  3221  of the insurance law, as amended by section 1 of part K of chapter
    11  82 of the laws of 2002, is amended to read as follows:
    12    (C)  Coverage  of  diagnostic  and  treatment  procedures,   including
    13  prescription  drugs,  used in the diagnosis and treatment of infertility
    14  as required by subparagraphs (A) and (B)  of  this  paragraph  shall  be
    15  provided in accordance with the provisions of this subparagraph.
    16    (i)  [Coverage  shall  be  provided  for persons whose ages range from
    17  twenty-one through forty-four years, provided that nothing herein  shall
    18  preclude  the  provision  of  coverage  to persons whose age is below or
    19  above such range.
    20    (ii)] Diagnosis and treatment of infertility shall  be  prescribed  as
    21  part  of  a  physician's  overall  plan  of care and consistent with the
    22  guidelines for coverage as referenced in this subparagraph.
    23    [(iii)] (ii) Coverage may be subject to co-payments,  coinsurance  and
    24  deductibles  as  may  be deemed appropriate by the superintendent and as
    25  are consistent with those established for other benefits within a  given
    26  policy.
    27    [(iv)]  (iii)  Coverage shall be limited to those individuals who have
    28  been previously covered under the policy for a period of not  less  than
    29  twelve  months,  provided  that  for  the  purposes of this subparagraph
    30  "period of not less than twelve months" shall be determined by calculat-
    31  ing such time from either the date the insured was first  covered  under
    32  the  existing policy or from the date the insured was first covered by a
    33  previously in-force converted policy, whichever is earlier.
    34    [(v)] (iv) Coverage shall not be required to include the diagnosis and
    35  treatment of infertility in connection with: (I)  [in  vitro  fertiliza-
    36  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    37  transfers;  (II)]  the reversal of elective sterilizations; [(III)] (II)
    38  sex change procedures; [(IV)] (III) cloning; or [(V)]  (IV)  medical  or
    39  surgical  services  or  procedures that are deemed to be experimental in
    40  accordance with clinical guidelines referenced in clause [(vi)]  (v)  of
    41  this subparagraph.
    42    [(vi)]  (v)  The superintendent, in consultation with the commissioner
    43  of health, shall promulgate regulations which shall stipulate the guide-
    44  lines and standards which shall be used in carrying out  the  provisions
    45  of this subparagraph, which shall include:
    46    (I)  The determination of "infertility" in accordance with the [stand-
    47  ards and guidelines established and adopted by the American  College  of
    48  Obstetricians  and  Gynecologists and the American Society for Reproduc-
    49  tive Medicine] definitions of infertility and iatrogenic infertility  in
    50  paragraphs  one  and two of subsection (a) of section three thousand two
    51  hundred forty-two of this chapter;
    52    (II) The identification of experimental procedures and treatments  not
    53  covered  for  the  diagnosis  and treatment of infertility determined in
    54  accordance with the standards and guidelines established and adopted  by
    55  the American College of Obstetricians and Gynecologists and the American
    56  Society for Reproductive Medicine;

        A. 10137                            3
 
     1    (III)  The  identification  of  the  required training, experience and
     2  other standards for health care providers for the  provision  of  proce-
     3  dures  and  treatments  for  the  diagnosis and treatment of infertility
     4  determined in accordance with the standards and  guidelines  established
     5  and  adopted  by the American College of Obstetricians and Gynecologists
     6  and the American Society for Reproductive Medicine; and
     7    (IV) The determination of appropriate medical candidates by the treat-
     8  ing physician in accordance with the  standards  and  guidelines  estab-
     9  lished and adopted by the American College of Obstetricians and Gynecol-
    10  ogists and/or the American Society for Reproductive Medicine.
    11    §  3.  Paragraph  3 of subsection (s) of section 4303 of the insurance
    12  law, as amended by section 2 of part K of chapter  82  of  the  laws  of
    13  2002, is amended to read as follows:
    14    (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
    15  prescription drugs used in the diagnosis and treatment of infertility as
    16  required by paragraphs one and two of this subsection shall be  provided
    17  in accordance with this paragraph.
    18    (A)  [Coverage  shall  be  provided  for persons whose ages range from
    19  twenty-one through forty-four years, provided that nothing herein  shall
    20  preclude  the  provision  of  coverage  to persons whose age is below or
    21  above such range.
    22    (B)] Diagnosis and treatment of infertility  shall  be  prescribed  as
    23  part  of  a  physician's  overall  plan  of care and consistent with the
    24  guidelines for coverage as referenced in this paragraph.
    25    [(C)] (B) Coverage may be  subject  to  co-payments,  coinsurance  and
    26  deductibles  as  may  be deemed appropriate by the superintendent and as
    27  are consistent with those established for other benefits within a  given
    28  policy.
    29    [(D)] (C) Coverage shall be limited to those individuals who have been
    30  previously covered under the policy for a period of not less than twelve
    31  months,  provided that for the purposes of this paragraph "period of not
    32  less than twelve months" shall be determined by  calculating  such  time
    33  from  either  the  date the insured was first covered under the existing
    34  policy or from the date the insured was first covered  by  a  previously
    35  in-force converted policy, whichever is earlier.
    36    [(E)]  (D) Coverage shall not be required to include the diagnosis and
    37  treatment of infertility in connection with: (i)  [in  vitro  fertiliza-
    38  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    39  transfers;  (ii)]  the reversal of elective sterilizations; [(iii)] (ii)
    40  sex change procedures; [(iv)] (iii) cloning; or [(v)]  (iv)  medical  or
    41  surgical  services  or  procedures that are deemed to be experimental in
    42  accordance with clinical guidelines referenced in subparagraph [(F)] (E)
    43  of this paragraph.
    44    [(F)] (E) The superintendent, in consultation with the commissioner of
    45  health, shall promulgate regulations which shall  stipulate  the  guide-
    46  lines  and  standards which shall be used in carrying out the provisions
    47  of this paragraph, which shall include:
    48    (i) The determination of "infertility" in accordance with the  [stand-
    49  ards  and  guidelines established and adopted by the American College of
    50  Obstetricians and Gynecologists and the American Society  for  Reproduc-
    51  tive  Medicine] definitions of infertility and iatrogenic infertility in
    52  paragraphs one and two of subsection (a) of section three  thousand  two
    53  hundred forty-two of this chapter;
    54    (ii)  The identification of experimental procedures and treatments not
    55  covered for the diagnosis and treatment  of  infertility  determined  in
    56  accordance  with the standards and guidelines established and adopted by

        A. 10137                            4
 
     1  the American College of Obstetricians and Gynecologists and the American
     2  Society for Reproductive Medicine;
     3    (iii)  The  identification  of  the  required training, experience and
     4  other standards for health care providers for the  provision  of  proce-
     5  dures  and  treatments  for  the  diagnosis and treatment of infertility
     6  determined in accordance with the standards and  guidelines  established
     7  and  adopted  by the American College of Obstetricians and Gynecologists
     8  and the American Society for Reproductive Medicine; and
     9    (iv) The determination of appropriate medical candidates by the treat-
    10  ing physician in accordance with the  standards  and  guidelines  estab-
    11  lished and adopted by the American College of Obstetricians and Gynecol-
    12  ogists and/or the American Society for Reproductive Medicine.
    13    § 4. This act shall take effect immediately.
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