STATE OF NEW YORK
________________________________________________________________________
719
2019-2020 Regular Sessions
IN SENATE(Prefiled)
January 9, 2019
___________
Introduced by Sens. SAVINO, BIAGGI -- 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 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. Paragraph 13 of subsection (i) of section 3216 of the
2 insurance law is amended by adding three new subparagraphs (C), (D) and
3 (E) to read as follows:
4 (C) Every policy delivered or issued for delivery in this state that
5 provides coverage for hospital, surgical or medical care shall provide
6 coverage for:
7 (i) in vitro fertilization used in the treatment of infertility; and
8 (ii) standard fertility preservation services when a necessary medical
9 treatment may directly or indirectly cause iatrogenic infertility to a
10 covered person.
11 (D) (i) For the purposes of subparagraph (C) of this paragraph,
12 "infertility" means a disease or condition characterized by the incapac-
13 ity to impregnate another person or to conceive, as diagnosed or deter-
14 mined (I) by a physician licensed to practice medicine in this state, or
15 (II) by the failure to establish a clinical pregnancy after twelve
16 months of regular, unprotected sexual intercourse, or after six months
17 of regular, unprotected sexual intercourse in the case of a female thir-
18 ty-five years of age or older.
19 (ii) For the purposes of subparagraph (C) of this paragraph, "iatro-
20 genic infertility" means an impairment of fertility by surgery, radi-
21 ation, chemotherapy or other medical treatment affecting reproductive
22 organs or processes.
23 (E) No insurer providing coverage under this paragraph shall discrimi-
24 nate based on a covered individual's expected length of life, present or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01402-02-9
S. 719 2
1 predicted disability, degree of medical dependency, perceived quality of
2 life, or other health conditions, nor based on personal characteristics,
3 including age, sex, sexual orientation, marital status or gender identi-
4 ty.
5 § 2. Paragraph 6 of subsection (k) of section 3221 of the insurance
6 law is amended by adding three new subparagraphs (E), (F) and (G) to
7 read as follows:
8 (E) Every group policy delivered or issued for delivery in this state
9 that provides hospital, surgical or medical coverage shall provide
10 coverage for:
11 (i) in vitro fertilization used in the treatment of infertility; and
12 (ii) standard fertility preservation services when a necessary medical
13 treatment may directly or indirectly cause iatrogenic infertility to a
14 covered person.
15 (F) (i) For the purposes of subparagraph (E) of this paragraph,
16 "infertility" means a disease or condition characterized by the incapac-
17 ity to impregnate another person or to conceive, as diagnosed or deter-
18 mined (I) by a physician licensed to practice medicine in this state, or
19 (II) by the failure to establish a clinical pregnancy after twelve
20 months of regular, unprotected sexual intercourse, or after six months
21 of regular, unprotected sexual intercourse in the case of a female thir-
22 ty-five years of age or older.
23 (ii) For the purposes of subparagraph (E) of this paragraph, "iatro-
24 genic infertility" means an impairment of fertility by surgery, radi-
25 ation, chemotherapy or other medical treatment affecting reproductive
26 organs or processes.
27 (G) No insurer providing coverage under this paragraph shall discrimi-
28 nate based on a covered individual's expected length of life, present or
29 predicted disability, degree of medical dependency, perceived quality of
30 life, or other health conditions, nor based on personal characteristics,
31 including age, sex, sexual orientation, marital status or gender identi-
32 ty.
33 § 3. Subsection (s) of section 4303 of the insurance law, as amended
34 by section 2 of part K of chapter 82 of the laws of 2002, is amended by
35 adding three new paragraphs (5), (6) and (7) to read as follows:
36 (5) Every contract issued by a medical expense indemnity corporation,
37 hospital service corporation or health service corporation for delivery
38 in this state that provides hospital, surgical or medical coverage shall
39 provide coverage for:
40 (A) in vitro fertilization used in the treatment of infertility; and
41 (B) standard fertility preservation services when a necessary medical
42 treatment may directly or indirectly cause iatrogenic infertility to a
43 covered person.
44 (6) (A) For the purposes of paragraph five of this subsection, "infer-
45 tility" means a disease or condition characterized by the incapacity to
46 impregnate another person or to conceive, as diagnosed or determined (i)
47 by a physician licensed to practice medicine in this state, or (ii) by
48 the failure to establish a clinical pregnancy after twelve months of
49 regular, unprotected sexual intercourse, or after six months of regular,
50 unprotected sexual intercourse in the case of a female thirty-five years
51 of age or older.
52 (B) For the purposes of paragraph five of this subsection, "iatrogenic
53 infertility" means an impairment of fertility by surgery, radiation,
54 chemotherapy or other medical treatment affecting reproductive organs or
55 processes.
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1 (7) No medical expense indemnity corporation, hospital service corpo-
2 ration or health service corporation providing coverage under this
3 subsection shall discriminate based on a covered individual's expected
4 length of life, present or predicted disability, degree of medical
5 dependency, perceived quality of life, or other health conditions, nor
6 based on personal characteristics, including age, sex, sexual orien-
7 tation, marital status or gender identity.
8 § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221
9 of the insurance law, as amended by section 1 of part K of chapter 82 of
10 the laws of 2002, is amended to read as follows:
11 (C) Coverage of diagnostic and treatment procedures, including
12 prescription drugs, used in the diagnosis and treatment of infertility
13 as required by subparagraphs (A) and (B) of this paragraph shall be
14 provided in accordance with the provisions of this subparagraph.
15 (i) [Coverage shall be provided for persons whose ages range from
16 twenty-one through forty-four years, provided that nothing herein shall
17 preclude the provision of coverage to persons whose age is below or
18 above such range.
19 (ii)] Diagnosis and treatment of infertility shall be prescribed as
20 part of a physician's overall plan of care and consistent with the
21 guidelines for coverage as referenced in this subparagraph.
22 [(iii)] (ii) Coverage may be subject to co-payments, coinsurance and
23 deductibles as may be deemed appropriate by the superintendent and as
24 are consistent with those established for other benefits within a given
25 policy.
26 [(iv) Coverage shall be limited to those individuals who have been
27 previously covered under the policy for a period of not less than twelve
28 months, provided that for the purposes of this subparagraph "period of
29 not less than twelve months" shall be determined by calculating such
30 time from either the date the insured was first covered under the exist-
31 ing policy or from the date the insured was first covered by a previous-
32 ly in-force converted policy, whichever is earlier.
33 (v)] (iii) Coverage shall not be required to include the diagnosis and
34 treatment of infertility in connection with: (I) [in vitro fertiliza-
35 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
36 transfers; (II)] the reversal of elective sterilizations; [(III)] (II)
37 sex change procedures; [(IV)] (III) cloning; or [(V)] (IV) medical or
38 surgical services or procedures that are deemed to be experimental in
39 accordance with clinical guidelines referenced in clause [(vi)] (iv) of
40 this subparagraph.
41 [(vi)] (iv) The superintendent, in consultation with the commissioner
42 of health, shall promulgate regulations which shall stipulate the guide-
43 lines and standards which shall be used in carrying out the provisions
44 of this subparagraph, which shall include:
45 (I) [The determination of "infertility" in accordance with the stand-
46 ards and guidelines established and adopted by the American College of
47 Obstetricians and Gynecologists and the American Society for Reproduc-
48 tive Medicine;
49 (II)] The identification of experimental procedures and treatments not
50 covered for the diagnosis and treatment of infertility determined in
51 accordance with the standards and guidelines established and adopted by
52 the American College of Obstetricians and Gynecologists and the American
53 Society for Reproductive Medicine;
54 [(III)] (II) The identification of the required training, experience
55 and other standards for health care providers for the provision of
56 procedures and treatments for the diagnosis and treatment of infertility
S. 719 4
1 determined in accordance with the standards and guidelines established
2 and adopted by the American College of Obstetricians and Gynecologists
3 and the American Society for Reproductive Medicine; and
4 [(IV)] (III) The determination of appropriate medical candidates by
5 the treating physician in accordance with the standards and guidelines
6 established and adopted by the American College of Obstetricians and
7 Gynecologists and/or the American Society for Reproductive Medicine.
8 § 5. Paragraph 3 of subsection (s) of section 4303 of the insurance
9 law, as amended by section 2 of part K of chapter 82 of the laws of
10 2002, is amended to read as follows:
11 (3) Coverage of diagnostic and treatment procedures, including
12 prescription drugs used in the diagnosis and treatment of infertility as
13 required by paragraphs one and two of this subsection shall be provided
14 in accordance with this paragraph.
15 (A) [Coverage shall be provided for persons whose ages range from
16 twenty-one through forty-four years, provided that nothing herein shall
17 preclude the provision of coverage to persons whose age is below or
18 above such range.
19 (B)] Diagnosis and treatment of infertility shall be prescribed as
20 part of a physician's overall plan of care and consistent with the
21 guidelines for coverage as referenced in this paragraph.
22 [(C)] (B) Coverage may be subject to co-payments, coinsurance and
23 deductibles as may be deemed appropriate by the superintendent and as
24 are consistent with those established for other benefits within a given
25 policy.
26 [(D) Coverage shall be limited to those individuals who have been
27 previously covered under the policy for a period of not less than twelve
28 months, provided that for the purposes of this paragraph "period of not
29 less than twelve months" shall be determined by calculating such time
30 from either the date the insured was first covered under the existing
31 policy or from the date the insured was first covered by a previously
32 in-force converted policy, whichever is earlier.
33 (E)] (C) Coverage shall not be required to include the diagnosis and
34 treatment of infertility in connection with: (i) [in vitro fertiliza-
35 tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
36 transfers; (ii)] the reversal of elective sterilizations; [(iii)] (ii)
37 sex change procedures; [(iv)] (iii) cloning; or [(v)] (iv) medical or
38 surgical services or procedures that are deemed to be experimental in
39 accordance with clinical guidelines referenced in subparagraph [(F)] (D)
40 of this paragraph.
41 [(F)] (D) The superintendent, in consultation with the commissioner of
42 health, shall promulgate regulations which shall stipulate the guide-
43 lines and standards which shall be used in carrying out the provisions
44 of this paragraph, which shall include:
45 (i) [The determination of "infertility" in accordance with the stand-
46 ards and guidelines established and adopted by the American College of
47 Obstetricians and Gynecologists and the American Society for Reproduc-
48 tive Medicine;
49 (ii)] The identification of experimental procedures and treatments not
50 covered for the diagnosis and treatment of infertility determined in
51 accordance with the standards and guidelines established and adopted by
52 the American College of Obstetricians and Gynecologists and the American
53 Society for Reproductive Medicine;
54 [(iii)] (ii) The identification of the required training, experience
55 and other standards for health care providers for the provision of
56 procedures and treatments for the diagnosis and treatment of infertility
S. 719 5
1 determined in accordance with the standards and guidelines established
2 and adopted by the American College of Obstetricians and Gynecologists
3 and the American Society for Reproductive Medicine; and
4 [(iv)] (iii) The determination of appropriate medical candidates by
5 the treating physician in accordance with the standards and guidelines
6 established and adopted by the American College of Obstetricians and
7 Gynecologists and/or the American Society for Reproductive Medicine.
8 § 6. This act shall take effect on the first day of January next
9 succeeding the date on which it shall have become a law and shall apply
10 to all policies issued, renewed, altered or modified on or after such
11 date.
