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A10588 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          10588
 
                   IN ASSEMBLY
 
                                      June 20, 2024
                                       ___________
 
        Introduced   by   COMMITTEE  ON  RULES  --  (at  request  of  M.  of  A.
          Bichotte Hermelyn) -- read once  and  referred  to  the  Committee  on
          Insurance
 
        AN  ACT  to  amend the insurance law, in relation to expanding insurance
          coverage of in vitro fertilization, including individual health insur-
          ance policy coverage

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section 1. Item (vii) of subparagraph (C) of paragraph 6 of subsection
     2  (k)  of  section  3221  of the insurance law, as amended by section 1 of
     3  part L of chapter 57 of the laws of 2019, is amended to read as follows:
     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 in-vitro]
     7  complete oocyte retrievals and in vitro fertilization used in the treat-
     8  ment of infertility with unlimited embryo transfers from fresh or frozen
     9  oocytes or embryos from a covered retrieval. Coverage may be subject  to
    10  annual  deductibles  and  coinsurance,  including  copayments, as may be
    11  deemed appropriate by the superintendent  and  as  are  consistent  with
    12  those  established  for  other  benefits  within  a  given  policy. [For
    13  purposes of this item, a "cycle" is defined as either all treatment that
    14  starts when: preparatory medications are administered for ovarian stimu-
    15  lation for oocyte retrieval  with  the  intent  of  undergoing  in-vitro
    16  fertilization using a fresh embryo transfer; or medications are adminis-
    17  tered for endometrial preparation with the intent of undergoing in-vitro
    18  fertilization using a frozen embryo transfer.]
    19    § 2. Subparagraph (G) of paragraph 3 of subsection (s) of section 4303
    20  of the insurance law, as amended by section 2 of part L of chapter 57 of
    21  the laws of 2019, is amended to read as follows:
    22    (G) Every large group contract that provides medical, major medical or
    23  similar  comprehensive-type  coverage  shall  provide coverage for three
    24  [cycles of in-vitro] complete oocyte retrievals and in vitro  fertiliza-
    25  tion  used  in the treatment of infertility with unlimited embryo trans-
    26  fers from fresh or frozen oocytes or embryos from a  covered  retrieval.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15362-01-4

        A. 10588                            2
 
     1  Coverage may be subject to annual deductibles and coinsurance, including
     2  copayments,  as  may  be deemed appropriate by the superintendent and as
     3  are consistent with those established for other benefits within a  given
     4  contract.  [For  purposes  of this subparagraph, a "cycle" is defined as
     5  either all treatment  that  starts  when:  preparatory  medications  are
     6  administered  for  ovarian  stimulation  for  oocyte  retrieval with the
     7  intent of undergoing in-vitro fertilization using a fresh embryo  trans-
     8  fer;  or  medications  are administered for endometrial preparation with
     9  the intent of undergoing in-vitro fertilization using  a  frozen  embryo
    10  transfer.]
    11    §  3.  Paragraph 13 of subsection (i) of section 3216 of the insurance
    12  law, as added by chapter 897 of the laws of 1990 and renumbered by chap-
    13  ter 131 of the laws of 1992 and subparagraph (C) as added by  section  3
    14  of  part  L  of  chapter  57  of the laws of 2019, is amended to read as
    15  follows:
    16    (13) (A) Every policy which provides coverage for hospital care  shall
    17  not  exclude  coverage  for hospital care for diagnosis and treatment of
    18  correctable medical conditions otherwise covered by  the  policy  solely
    19  because  the  medical  condition  results  in  infertility[.]; provided,
    20  however that:
    21    (i) subject to the provisions of subparagraph (C) of  this  paragraph,
    22  in  no  case  shall such coverage exclude surgical or medical procedures
    23  provided as part of such hospital care which would correct malformation,
    24  disease or dysfunction resulting in infertility; and
    25    (ii) provided, further however, that  subject  to  the  provisions  of
    26  subparagraph  (C)  of  this  paragraph,  in  no case shall such coverage
    27  exclude diagnostic tests and procedures provided as part of such  hospi-
    28  tal  care that are necessary to determine infertility or that are neces-
    29  sary  in  connection  with  any  surgical  or  medical   treatments   or
    30  prescription  drug coverage provided pursuant to this paragraph, includ-
    31  ing such diagnostic tests and procedures as hysterosalpingogram, hyster-
    32  oscopy, endometrial biopsy, laparoscopy, sono-hysterogram,  post  coital
    33  tests, testis biopsy, semen analysis, blood tests and ultrasound; and
    34    (iii)  provided,  further  however,  every  such policy which provides
    35  coverage for prescription drugs shall  include,  within  such  coverage,
    36  coverage  for  prescription  drugs approved by the federal Food and Drug
    37  Administration for use in the diagnosis and treatment of infertility  in
    38  accordance with subparagraph (C) of this paragraph.
    39    (B) Every policy which provides coverage for surgical and medical care
    40  shall  not  exclude coverage for surgical and medical care for diagnosis
    41  and treatment of correctable medical conditions otherwise covered by the
    42  policy solely because the medical condition results  in  infertility[.];
    43  provided, however that:
    44    (i)  subject  to the provisions of subparagraph (C) of this paragraph,
    45  in no case shall such coverage exclude surgical  or  medical  procedures
    46  which  would  correct  malformation, disease or dysfunction resulting in
    47  infertility; and
    48    (ii) provided, further however, that  subject  to  the  provisions  of
    49  subparagraph  (C)  of  this  paragraph,  in  no case shall such coverage
    50  exclude diagnostic tests and procedures that are necessary to  determine
    51  infertility  or  that  are  necessary in connection with any surgical or
    52  medical treatments or prescription drug coverage  provided  pursuant  to
    53  this  paragraph,  including  such  diagnostic  tests  and  procedures as
    54  hysterosalpingogram,  hysteroscopy,  endometrial  biopsy,   laparoscopy,
    55  sono-hysterogram,  post  coital  tests,  testis  biopsy, semen analysis,
    56  blood tests and ultrasound; and

        A. 10588                            3
 
     1    (iii) provided, further however,  every  such  policy  which  provides
     2  coverage  for  prescription  drugs  shall include, within such coverage,
     3  coverage for prescription drugs approved by the federal  Food  and  Drug
     4  Administration  for use in the diagnosis and treatment of infertility in
     5  accordance with subparagraph (C) of this paragraph.
     6    (C)  [Every  policy  that  provides  medical, major medical or similar
     7  comprehensive-type coverage shall  provide  coverage  for]  Coverage  of
     8  diagnostic  and treatment procedures, including prescription drugs, used
     9  in the diagnosis and treatment of infertility as  required  by  subpara-
    10  graphs  (A)  and  (B)  of this paragraph shall be provided in accordance
    11  with the provisions of this subparagraph.
    12    (i) Diagnosis and treatment of infertility shall be prescribed as part
    13  of a physician's overall plan of care and consistent with the guidelines
    14  for coverage as referenced in this subparagraph.
    15    (ii) Coverage may be subject to co-payments, coinsurance  and  deduct-
    16  ibles  as  may  be  deemed  appropriate by the superintendent and as are
    17  consistent with those established for  other  benefits  within  a  given
    18  policy.
    19    (iii) Except as provided in items (vi) and (vii) of this subparagraph,
    20  coverage shall not be required to include the diagnosis and treatment of
    21  infertility  in  connection  with:  (I)  in  vitro fertilization, gamete
    22  intrafallopian tube transfers or zygote intrafallopian  tube  transfers;
    23  (II)  the  reversal  of elective sterilizations; (III) sex change proce-
    24  dures; (IV) cloning; or (V) medical or surgical services  or  procedures
    25  that  are  deemed  to be experimental in accordance with clinical guide-
    26  lines referenced in item (iv) of this subparagraph.
    27    (iv) The superintendent, in  consultation  with  the  commissioner  of
    28  health,  shall  promulgate  regulations which shall stipulate the guide-
    29  lines and standards which shall be used in carrying out  the  provisions
    30  of this subparagraph, which shall include:
    31    (I)  The  identification of experimental procedures and treatments not
    32  covered for the diagnosis and treatment  of  infertility  determined  in
    33  accordance  with the standards and guidelines established and adopted by
    34  the American College of Obstetricians and Gynecologists and the American
    35  Society for Reproductive Medicine;
    36    (II) The identification of the required training, experience and other
    37  standards for health care providers for the provision of procedures  and
    38  treatments  for the diagnosis and treatment of infertility determined in
    39  accordance with the standards and guidelines established and adopted  by
    40  the American College of Obstetricians and Gynecologists and the American
    41  Society for Reproductive Medicine; and
    42    (III)  The  determination  of  appropriate  medical  candidates by the
    43  treating physician in  accordance  with  the  standards  and  guidelines
    44  established  and  adopted  by  the American College of Obstetricians and
    45  Gynecologists and/or the American Society for Reproductive Medicine.
    46    (v)  Coverage  shall  also  include  standard  fertility  preservation
    47  services  when  a  medical  treatment  may  directly or indirectly cause
    48  iatrogenic infertility to an insured. Coverage may be subject to  annual
    49  deductibles  and  coinsurance,  including  copayments,  as may be deemed
    50  appropriate by the superintendent  and  as  are  consistent  with  those
    51  established for other benefits within a given policy.
    52    (vi)  Every  policy  which  provides  coverage for hospital care shall
    53  provide coverage for three  complete  oocyte  retrievals  and  in  vitro
    54  fertilization used in the treatment of infertility with unlimited embryo
    55  transfers  from  fresh  or  frozen  oocytes  or  embryos  from a covered
    56  retrieval. Coverage may be subject to  annual  deductibles  and  coinsu-

        A. 10588                            4
 
     1  rance,  including copayments, as may be deemed appropriate by the super-
     2  intendent and as are consistent with those established for  other  bene-
     3  fits within a given policy.
     4    (vii)  (I)  For  the purposes of this paragraph, "infertility" means a
     5  disease or condition  characterized  by  the  incapacity  to  impregnate
     6  another  person  or  to  conceive, defined by the failure to establish a
     7  clinical pregnancy after twelve months of  regular,  unprotected  sexual
     8  intercourse  or  therapeutic  donor insemination, or after six months of
     9  regular, unprotected sexual intercourse or therapeutic  donor  insemina-
    10  tion  for a female thirty-five years of age or older. Earlier evaluation
    11  and treatment may be warranted based on an individual's medical  history
    12  or physical findings.
    13    [(i)]  (II) For purposes of this [subparagraph] paragraph, "iatrogenic
    14  infertility" means an impairment of  fertility  by  surgery,  radiation,
    15  chemotherapy or other medical treatment affecting reproductive organs or
    16  processes.
    17    [(ii)] (viii) No insurer providing coverage under this paragraph shall
    18  discriminate  based  on an insured's expected length of life, present or
    19  predicted disability, degree of medical dependency, perceived quality of
    20  life, or other health conditions, nor based on personal characteristics,
    21  including age, sex, sexual orientation, marital status or gender identi-
    22  ty.
    23    (D) Every policy that provides  coverage  for  prescription  fertility
    24  drugs and requires or permits prescription drugs to be purchased through
    25  a  network  participating  mail order or other non-retail pharmacy shall
    26  provide the same coverage for prescription  fertility  drugs  when  such
    27  drugs  are  purchased from a network participating non-mail order retail
    28  pharmacy provided that the network participating non-mail  order  retail
    29  pharmacy  agrees  in advance through a contractual network agreement, to
    30  the same reimbursement amount, as well as the same applicable terms  and
    31  conditions, that the insurer has established for a network participating
    32  mail  order or other non-retail pharmacy. In such case, the policy shall
    33  not impose any fee, co-payment, coinsurance, deductible or other  condi-
    34  tion on any covered person who elects to purchase prescription fertility
    35  drugs  through  a  network  participating non-mail order retail pharmacy
    36  that it does not impose on any covered person who purchases prescription
    37  fertility drugs through a network  participating  mail  order  or  other
    38  non-retail  pharmacy;  provided,  however,  that  the provisions of this
    39  section shall not supersede the terms of a collective bargaining  agree-
    40  ment  or apply to a policy that is the result of a collective bargaining
    41  agreement between an employer and a  recognized  or  certified  employee
    42  organization.
    43    §  4.  This  act shall take effect January 1, 2025, and shall apply to
    44  policies and contracts issued, renewed, modified, altered or amended  on
    45  or after such date.
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