S02669 Summary:
BILL NO | S02669 |
  | |
SAME AS | No same as |
  | |
SPONSOR | KRUGER |
  | |
COSPNSR | |
  | |
MLTSPNSR | |
  | |
Amd SS3216, 3221 & 4303, Ins L | |
  | |
Makes various provisions regarding health insurance coverage including requiring certain policies to cover bone density measurement and other drug therapy; removes the deductible from coverage for cervical cytological screening and mammograms; extends mammogram eligibility to persons forty and over; requires prescription drug coverage to include contraceptives; requires notice of availability of obstetrical and gynecological services; requires coverage for diagnostic testing and treatment of infertility. |
S02669 Actions:
BILL NO | S02669 | |||||||||||||||||||||||||||||||||||||||||||||||||
  | ||||||||||||||||||||||||||||||||||||||||||||||||||
01/28/2011 | REFERRED TO INSURANCE |
S02669 Floor Votes:
There are no votes for this bill in this legislative session.
Go to topS02669 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 2669 2011-2012 Regular Sessions IN SENATE January 28, 2011 ___________ Introduced by Sen. KRUGER -- 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 health insurance coverage for diagnostic testing and treatment for infertility The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 28 to read as follows: 3 (28) (A) Every policy delivered or issued for delivery in this state 4 which provides medical coverage that includes coverage for physician 5 services in a physician's office and every policy which provides major 6 medical or similar comprehensive-type coverage shall provide coverage 7 for the diagnosis and treatment of infertility, including, but not 8 limited to, drug therapy, artificial insemination, in vitro fertiliza- 9 tion, intracytoplasmic sperm injection, gamete donation, embryo 10 donation, assisted hatching, uterine embryo lavage, embryo transfer, 11 gamete intrafallopian tube transfer, zygote intrafallopian tube trans- 12 fer, low tubal ovum transfer, gamete preservation, embryo preservation 13 and any other medically or surgically indicated service or procedure 14 that is used to treat infertility or induce pregnancy, except that if 15 the group or entity on whose behalf the policy is issued is, or is 16 controlled by, a religious or denominational group or entity, nothing in 17 this section shall require the policy to cover any diagnosis or treat- 18 ment that is contrary to the religious tenets of such group or entity. 19 (B) The coverage required under subparagraph (A) of this paragraph is 20 subject to the following conditions: 21 (i) The terms of such coverage, including, but not limited to, co-pay- 22 ments, deductibles and access to out-of-network providers, shall be 23 consistent with the coverage provided in the policy for the specialty 24 treatment of any other disease. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07241-01-1S. 2669 2 1 (ii) Coverage for procedures for in vitro fertilization, intracyto- 2 plasmic sperm injection, assisted hatching, gamete donation, embryo 3 donation, embryo transfer, gamete intrafallopian tube transfer or zygote 4 intrafallopian tube transfer shall be required only if: 5 (a) The covered individual has been unable to attain or sustain a 6 successful pregnancy through reasonable, less costly medically appropri- 7 ate infertility treatments for which coverage is available under the 8 policy, plan or contract; 9 (b) The covered individual has not undergone four completed oocyte 10 retrievals, each of which has resulted in at least one completed embryo 11 transfer, except that if a live birth follows a completed oocyte 12 retrieval and embryo transfer, then coverage shall be required for two 13 additional completed oocyte retrievals each of which results in at least 14 one completed embryo transfer; and 15 (c) The procedures are performed at medical facilities that conform to 16 the American College of Obstetric and Gynecology guidelines for in vitro 17 fertilization clinics or to the American Society for Reproductive Medi- 18 cine minimal standards for programs of in vitro fertilization. 19 (iii) For purposes of this section, "infertility" means the inability 20 to conceive after one year of unprotected sexual intercourse or the 21 inability to sustain a successful pregnancy or the presence of a demon- 22 strated condition in the male or female partner recognized by a licensed 23 physician as a cause of the inability to conceive or sustain a pregnancy 24 to a live birth. 25 § 2. Subsection (k) of section 3221 of the insurance law is amended by 26 adding a new paragraph 17 to read as follows: 27 (17)(A) Every policy delivered or issued for delivery in this state 28 which provides medical coverage that includes coverage for physician 29 services in a physician's office and every policy which provides major 30 medical or similar comprehensive-type coverage shall provide coverage 31 for the diagnosis and treatment of infertility, including, but not 32 limited to, drug therapy, artificial insemination, in vitro fertiliza- 33 tion, intracytoplasmic sperm injection, gamete donation, embryo 34 donation, assisted hatching, uterine embryo lavage, embryo transfer, 35 gamete intrafallopian tube transfer, zygote intrafallopian tube trans- 36 fer, low tubal ovum transfer, gamete preservation, embryo preservation 37 and any other medically or surgically indicated service or procedure 38 that is used to treat infertility or induce pregnancy, except that if 39 the group or entity on whose behalf the policy is issued is, or is 40 controlled by, a religious or denominational group or entity, nothing in 41 this section shall require the policy to cover any diagnosis or treat- 42 ment that is contrary to the religious tenets of such group or entity. 43 (B) The coverage required under subparagraph (A) of this paragraph is 44 subject to the following conditions: 45 (i) The terms of such coverage, including, but not limited to, co-pay- 46 ments, deductibles and access to out-of-network providers, shall be 47 consistent with the coverage provided in the policy for the specialty 48 treatment of any other disease. 49 (ii) Coverage for procedures for in vitro fertilization, intracyto- 50 plasmic sperm injection, assisted hatching, gamete donation, embryo 51 donation, embryo transfer, gamete intrafallopian tube transfer or zygote 52 intrafallopian tube transfer shall be required only if: 53 (a) The covered individual has been unable to attain or sustain a 54 successful pregnancy through reasonable, less costly medically appropri- 55 ate infertility treatments for which coverage is available under the 56 policy, plan or contract;S. 2669 3 1 (b) The covered individual has not undergone four completed oocyte 2 retrievals, each of which has resulted in at least one completed embryo 3 transfer, except that if a live birth follows a completed oocyte 4 retrieval and embryo transfer, then coverage shall be required for two 5 additional completed oocyte retrievals each of which results in at least 6 one completed embryo transfer; and 7 (c) The procedures are performed at medical facilities that conform to 8 the American College of Obstetric and Gynecology guidelines for in vitro 9 fertilization clinics or to the American Society for Reproductive Medi- 10 cine minimal standards for programs of in vitro fertilization. 11 (iii) For purposes of this section, "infertility" means the inability 12 to conceive after one year of unprotected sexual intercourse or the 13 inability to sustain a successful pregnancy or the presence of a demon- 14 strated condition in the male or female partner recognized by a licensed 15 physician as a cause of the inability to conceive or sustain a pregnancy 16 to a live birth. 17 § 3. Section 4303 of the insurance law is amended by adding a new 18 subsection (hh) to read as follows: 19 (hh) (1) Every policy delivered or issued for delivery in this state 20 which provides medical coverage that includes coverage for physician 21 services in a physician's office and every policy which provides major 22 medical or similar comprehensive-type coverage shall provide coverage 23 for the diagnosis and treatment of infertility, including, but not 24 limited to, drug therapy, artificial insemination, in vitro fertiliza- 25 tion, intracytoplasmic sperm injection, gamete donation, embryo 26 donation, assisted hatching, uterine embryo lavage, embryo transfer, 27 gamete intrafallopian tube transfer, zygote intrafallopian tube trans- 28 fer, low tubal ovum transfer, gamete preservation, embryo preservation 29 and any other medically or surgically indicated service or procedure 30 that is used to treat infertility or induce pregnancy, except that if 31 the group or entity on whose behalf the policy issued is, or is 32 controlled by, a religious or denominational group or entity, nothing in 33 this section shall require the policy to cover any diagnosis or treat- 34 ment that is contrary to the religious tenets of such group or entity. 35 (2) The coverage required under paragraph one of this subsection is 36 subject to the following conditions: 37 (A) The terms of such coverage, including, but not limited to, co-pay- 38 ments, deductibles and access to out-of-network providers, shall be 39 consistent with the coverage provided in the policy for the speciality 40 treatment of any other disease. 41 (B) Coverage for procedures for in vitro fertilization, intracyto- 42 plasmic sperm injection, assisted hatching, gamete donation, embryo 43 donation, embryo transfer, gamete intrafallopian tube transfer or zygote 44 intrafallopian tube transfer shall be required only if: 45 (i) The covered individual has been unable to attain or sustain a 46 successful pregnancy through reasonable, less costly medically appropri- 47 ate infertility treatments for which coverage is available under the 48 policy, plan or contract; 49 (ii) The covered individual has not undergone four completed oocyte 50 retrievals, each of which has resulted in at least one completed embryo 51 transfer, except that if a live birth follows a completed oocyte 52 retrieval and embryo transfer, then coverage shall be required for two 53 additional completed oocyte retrievals each of which results in at least 54 one completed embryo transfer; and 55 (iii) The procedures are performed at medical facilities that conform 56 to the American College of Obstetric and Gynecology guidelines for inS. 2669 4 1 vitro fertilization clinics or to the American Society for Reproductive 2 Medicine minimal standards for programs of in vitro fertilization. 3 (C) For purposes of this section, "infertility" mean the inability to 4 conceive after one year of unprotected sexual intercourse or the inabil- 5 ity to sustain a successful pregnancy or the presence of a demonstrated 6 condition in the male or female partner recognized by a licensed physi- 7 cian as a cause of the inability to conceive or sustain a pregnancy to a 8 live birth. 9 § 4. Subparagraph (B) of paragraph 11 of subsection (l) of section 10 3221 of the insurance law, as amended by chapter 554 of the laws of 11 2002, is amended to read as follows: 12 (B) Such coverage may not be subject to annual deductibles and coinsu- 13 rance [as may be deemed appropriate by the superintendent and as are14consistent with those established for other benefits within a given15policy]. 16 § 5. The closing paragraph of paragraph 1 of subsection (p) of section 17 4303 of the insurance law, as amended by chapter 554 of the laws of 18 2002, is amended to read as follows: 19 The coverage required in this paragraph may not be subject to annual 20 deductibles and coinsurance [as may be deemed appropriate by the super-21intendent and as are consistent with those established for other bene-22fits within a given policy]. 23 § 6. Subparagraph (C) of paragraph 14 of subsection (l) of section 24 3221 of the insurance law, as amended by chapter 554 of the laws of 25 2002, is amended to read as follows: 26 (C) Such coverage may not be subject to annual deductibles and coinsu- 27 rance [as may be deemed appropriate by the superintendent and as are28consistent with those established for other benefits within a given29policy]. 30 § 7. Paragraph 1 of subsection (t) of section 4303 of the insurance 31 law, as amended by chapter 554 of the laws of 2002, is amended to read 32 as follows: 33 (1) A medical expense indemnity corporation, a hospital service corpo- 34 ration or a health service corporation which provides coverage for 35 hospital, surgical, or medical care shall provide coverage for an annual 36 cervical cytology screening for cervical cancer and its precursor states 37 for women aged eighteen and older. Such coverage may not be subject to 38 annual deductibles and coinsurance [as may be deemed appropriate by the39superintendent and as are consistent with those established for other40benefits within a given contract]. 41 § 8. This act shall take effect on the first of January next succeed- 42 ing the date on which it shall have become a law and shall apply to all 43 policies issued, renewed, modified or altered on or after such effective 44 date.