Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.
STATE OF NEW YORK
________________________________________________________________________
6118--A
2023-2024 Regular Sessions
IN SENATE
March 30, 2023
___________
Introduced by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and
when printed to be committed to the Committee on Insurance -- recom-
mitted to the Committee on Insurance in accordance with Senate Rule 6,
sec. 8 -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to the definition of
infertility and health insurance coverage for in-vitro fertilization
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as "The Equity in
2 Fertility Treatment Act".
3 § 2. Items (v) and (vii) of subparagraph (C) of paragraph 6 of
4 subsection (k) of section 3221 of the insurance law, as amended by
5 section 1 of part L of chapter 57 of the laws of 2019, are amended to
6 read as follows:
7 (v)(I) For the purposes of this paragraph, "infertility" means a
8 disease or condition characterized by the incapacity to impregnate
9 another person or to conceive, defined by (a) the failure to establish a
10 clinical pregnancy after twelve months of regular, unprotected sexual
11 intercourse or therapeutic donor insemination, or after six months of
12 regular, unprotected sexual intercourse or therapeutic donor insemina-
13 tion for a female thirty-five years of age or older; (b) a person's
14 inability to reproduce either as a single individual or with their part-
15 ner without medical intervention; or (c) a licensed physician's or
16 osteopathic physician's findings based on a patient's medical, sexual,
17 or reproductive history, age, physical findings, or diagnostic testing.
18 Earlier evaluation and treatment may be warranted based on an individ-
19 ual's medical, sexual, or reproductive history [or], age, physical find-
20 ings, or diagnostic testing.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10106-04-3
S. 6118--A 2
1 (II) For purposes of this paragraph, "iatrogenic infertility" means an
2 impairment of fertility by surgery, radiation, chemotherapy or other
3 medical treatment affecting reproductive organs or processes.
4 (vii) Every large group policy delivered or issued for delivery in
5 this state that provides medical, major medical or similar comprehen-
6 sive-type coverage shall provide coverage for three [cycles of]
7 completed oocyte retrievals and in-vitro fertilization [used in the
8 treatment of infertility] with unlimited embryo transfers from fresh or
9 frozen oocytes or embryos from a covered retrieval, in accordance with
10 the guidelines of the American Society for Reproductive Medicine, using
11 single embryo transfer (SET) when recommended and medically appropriate
12 for the treatment of infertility. Coverage (I) shall not be denied based
13 on a covered individual's participation in fertility services provided
14 by or to a third party, and (II) may be subject to annual deductibles
15 and coinsurance, including copayments, as may be deemed appropriate by
16 the superintendent and as are consistent with those established for
17 other benefits within a given policy. [For purposes of this item, a
18 "cycle" is defined as either all treatment that starts when: preparatory
19 medications are administered for ovarian stimulation for oocyte
20 retrieval with the intent of undergoing in-vitro fertilization using a
21 fresh embryo transfer; or medications are administered for endometrial
22 preparation with the intent of undergoing in-vitro fertilization using a
23 frozen embryo transfer.]
24 § 3. Subparagraphs (E) and (G) of paragraph 3 of subsection (s) of
25 section 4303 of the insurance law, as amended by section 2 of part L of
26 chapter 57 of the laws of 2019, are amended to read as follows:
27 (E)(i) For the purposes of this subsection, "infertility" means a
28 disease or condition characterized by the incapacity to impregnate
29 another person or to conceive, defined by (a) the failure to establish a
30 clinical pregnancy after twelve months of regular, unprotected sexual
31 intercourse or therapeutic donor insemination, or after six months of
32 regular, unprotected sexual intercourse or therapeutic donor insemina-
33 tion for a female thirty-five years of age or older; (b) a person's
34 inability to reproduce either as a single individual or with their part-
35 ner without medical intervention; or (c) a licensed physician's or
36 osteopathic physician's findings based on a patient's medical, sexual,
37 or reproductive history, age, physical findings, or diagnostic testing.
38 Earlier evaluation and treatment may be warranted based on an individ-
39 ual's medical history or physical findings.
40 (ii) For purposes of this subsection, "iatrogenic infertility" means
41 an impairment of fertility by surgery, radiation, chemotherapy or other
42 medical treatment affecting reproductive organs or processes.
43 (G) Every large group contract that provides medical, major medical or
44 similar comprehensive-type coverage shall provide coverage for three
45 [cycles of] completed oocyte retrievals and in-vitro fertilization [used
46 in the treatment of infertility] with unlimited embryo transfers from
47 fresh or frozen oocytes or embryos from a covered retrieval, in accord-
48 ance with the guidelines of the American Society for Reproductive Medi-
49 cine, using single embryo transfer (SET) when recommended and medically
50 appropriate for the treatment of infertility. Coverage (i) shall not be
51 denied based on a covered individual's participation in fertility
52 services provided by or to a third party, and (ii) may be subject to
53 annual deductibles and coinsurance, including copayments, as may be
54 deemed appropriate by the superintendent and as are consistent with
55 those established for other benefits within a given contract. [For
56 purposes of this subparagraph, a "cycle" is defined as either all treat-
S. 6118--A 3
1 ment that starts when: preparatory medications are administered for
2 ovarian stimulation for oocyte retrieval with the intent of undergoing
3 in-vitro fertilization using a fresh embryo transfer; or medications are
4 administered for endometrial preparation with the intent of undergoing
5 in-vitro fertilization using a frozen embryo transfer.]
6 § 4. This act shall take effect immediately.
