Bill Text: NY A02817 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.
Spectrum: Partisan Bill (Democrat 34-0)
Status: (Introduced - Dead) 2020-01-08 - referred to ways and means [A02817 Detail]
Download: New_York-2019-A02817-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2817 2019-2020 Regular Sessions IN ASSEMBLY January 25, 2019 ___________ Introduced by M. of A. SIMOTAS, BICHOTTE, QUART, BRONSON, SOLAGES, BRAUNSTEIN, STECK, SEAWRIGHT, SIMON, PAULIN, BARRETT, HEVESI, LAVINE, CYMBROWITZ, MOSLEY, BUCHWALD, DINOWITZ, ROZIC, L. ROSENTHAL, OTIS, LIFTON, JEAN-PIERRE, WRIGHT, WEPRIN, ZEBROWSKI -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, LENTOL -- read once and referred 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- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01402-02-9A. 2817 2 1 ation, chemotherapy or other medical treatment affecting reproductive 2 organs or processes. 3 (E) No insurer providing coverage under this paragraph shall discrimi- 4 nate based on a covered individual's expected length of life, present or 5 predicted disability, degree of medical dependency, perceived quality of 6 life, or other health conditions, nor based on personal characteristics, 7 including age, sex, sexual orientation, marital status or gender identi- 8 ty. 9 § 2. Paragraph 6 of subsection (k) of section 3221 of the insurance 10 law is amended by adding three new subparagraphs (E), (F) and (G) to 11 read as follows: 12 (E) Every group policy delivered or issued for delivery in this state 13 that provides hospital, surgical or medical coverage shall provide 14 coverage for: 15 (i) in vitro fertilization used in the treatment of infertility; and 16 (ii) standard fertility preservation services when a necessary medical 17 treatment may directly or indirectly cause iatrogenic infertility to a 18 covered person. 19 (F) (i) For the purposes of subparagraph (E) of this paragraph, 20 "infertility" means a disease or condition characterized by the incapac- 21 ity to impregnate another person or to conceive, as diagnosed or deter- 22 mined (I) by a physician licensed to practice medicine in this state, or 23 (II) by the failure to establish a clinical pregnancy after twelve 24 months of regular, unprotected sexual intercourse, or after six months 25 of regular, unprotected sexual intercourse in the case of a female thir- 26 ty-five years of age or older. 27 (ii) For the purposes of subparagraph (E) of this paragraph, "iatro- 28 genic infertility" means an impairment of fertility by surgery, radi- 29 ation, chemotherapy or other medical treatment affecting reproductive 30 organs or processes. 31 (G) No insurer providing coverage under this paragraph shall discrimi- 32 nate based on a covered individual's expected length of life, present or 33 predicted disability, degree of medical dependency, perceived quality of 34 life, or other health conditions, nor based on personal characteristics, 35 including age, sex, sexual orientation, marital status or gender identi- 36 ty. 37 § 3. Subsection (s) of section 4303 of the insurance law, as amended 38 by section 2 of part K of chapter 82 of the laws of 2002, is amended by 39 adding three new paragraphs (5), (6) and (7) to read as follows: 40 (5) Every contract issued by a medical expense indemnity corporation, 41 hospital service corporation or health service corporation for delivery 42 in this state that provides hospital, surgical or medical coverage shall 43 provide coverage for: 44 (A) in vitro fertilization used in the treatment of infertility; and 45 (B) standard fertility preservation services when a necessary medical 46 treatment may directly or indirectly cause iatrogenic infertility to a 47 covered person. 48 (6) (A) For the purposes of paragraph five of this subsection, "infer- 49 tility" means a disease or condition characterized by the incapacity to 50 impregnate another person or to conceive, as diagnosed or determined (i) 51 by a physician licensed to practice medicine in this state, or (ii) by 52 the failure to establish a clinical pregnancy after twelve months of 53 regular, unprotected sexual intercourse, or after six months of regular, 54 unprotected sexual intercourse in the case of a female thirty-five years 55 of age or older.A. 2817 3 1 (B) For the purposes of paragraph five of this subsection, "iatrogenic 2 infertility" means an impairment of fertility by surgery, radiation, 3 chemotherapy or other medical treatment affecting reproductive organs or 4 processes. 5 (7) No medical expense indemnity corporation, hospital service corpo- 6 ration or health service corporation providing coverage under this 7 subsection shall discriminate based on a covered individual's expected 8 length of life, present or predicted disability, degree of medical 9 dependency, perceived quality of life, or other health conditions, nor 10 based on personal characteristics, including age, sex, sexual orien- 11 tation, marital status or gender identity. 12 § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221 13 of the insurance law, as amended by section 1 of part K of chapter 82 of 14 the laws of 2002, is amended to read as follows: 15 (C) Coverage of diagnostic and treatment procedures, including 16 prescription drugs, used in the diagnosis and treatment of infertility 17 as required by subparagraphs (A) and (B) of this paragraph shall be 18 provided in accordance with the provisions of this subparagraph. 19 (i) [Coverage shall be provided for persons whose ages range from20twenty-one through forty-four years, provided that nothing herein shall21preclude the provision of coverage to persons whose age is below or22above such range.23(ii)] Diagnosis and treatment of infertility shall be prescribed as 24 part of a physician's overall plan of care and consistent with the 25 guidelines for coverage as referenced in this subparagraph. 26 [(iii)] (ii) Coverage may be subject to co-payments, coinsurance and 27 deductibles as may be deemed appropriate by the superintendent and as 28 are consistent with those established for other benefits within a given 29 policy. 30 [(iv) Coverage shall be limited to those individuals who have been31previously covered under the policy for a period of not less than twelve32months, provided that for the purposes of this subparagraph "period of33not less than twelve months" shall be determined by calculating such34time from either the date the insured was first covered under the exist-35ing policy or from the date the insured was first covered by a previous-36ly in-force converted policy, whichever is earlier.37(v)] (iii) Coverage shall not be required to include the diagnosis and 38 treatment of infertility in connection with: (I) [in vitro fertiliza-39tion, gamete intrafallopian tube transfers or zygote intrafallopian tube40transfers; (II)] the reversal of elective sterilizations; [(III)] (II) 41 sex change procedures; [(IV)] (III) cloning; or [(V)] (IV) medical or 42 surgical services or procedures that are deemed to be experimental in 43 accordance with clinical guidelines referenced in clause [(vi)] (iv) of 44 this subparagraph. 45 [(vi)] (iv) The superintendent, in consultation with the commissioner 46 of health, shall promulgate regulations which shall stipulate the guide- 47 lines and standards which shall be used in carrying out the provisions 48 of this subparagraph, which shall include: 49 (I) [The determination of "infertility" in accordance with the stand-50ards and guidelines established and adopted by the American College of51Obstetricians and Gynecologists and the American Society for Reproduc-52tive Medicine;53(II)] The identification of experimental procedures and treatments not 54 covered for the diagnosis and treatment of infertility determined in 55 accordance with the standards and guidelines established and adopted byA. 2817 4 1 the American College of Obstetricians and Gynecologists and the American 2 Society for Reproductive Medicine; 3 [(III)] (II) The identification of the required training, experience 4 and other standards for health care providers for the provision of 5 procedures 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)] (III) The determination of appropriate medical candidates by 10 the treating physician in accordance with the standards and guidelines 11 established and adopted by the American College of Obstetricians and 12 Gynecologists and/or the American Society for Reproductive Medicine. 13 § 5. Paragraph 3 of subsection (s) of section 4303 of the insurance 14 law, as amended by section 2 of part K of chapter 82 of the laws of 15 2002, is amended to read as follows: 16 (3) Coverage of diagnostic and treatment procedures, including 17 prescription drugs used in the diagnosis and treatment of infertility as 18 required by paragraphs one and two of this subsection shall be provided 19 in accordance with this paragraph. 20 (A) [Coverage shall be provided for persons whose ages range from21twenty-one through forty-four years, provided that nothing herein shall22preclude the provision of coverage to persons whose age is below or23above such range.24(B)] Diagnosis and treatment of infertility shall be prescribed as 25 part of a physician's overall plan of care and consistent with the 26 guidelines for coverage as referenced in this paragraph. 27 [(C)] (B) Coverage may be subject to co-payments, coinsurance and 28 deductibles as may be deemed appropriate by the superintendent and as 29 are consistent with those established for other benefits within a given 30 policy. 31 [(D) Coverage shall be limited to those individuals who have been32previously covered under the policy for a period of not less than twelve33months, provided that for the purposes of this paragraph "period of not34less than twelve months" shall be determined by calculating such time35from either the date the insured was first covered under the existing36policy or from the date the insured was first covered by a previously37in-force converted policy, whichever is earlier.38(E)] (C) Coverage shall not be required to include the diagnosis and 39 treatment of infertility in connection with: (i) [in vitro fertiliza-40tion, gamete intrafallopian tube transfers or zygote intrafallopian tube41transfers; (ii)] the reversal of elective sterilizations; [(iii)] (ii) 42 sex change procedures; [(iv)] (iii) cloning; or [(v)] (iv) medical or 43 surgical services or procedures that are deemed to be experimental in 44 accordance with clinical guidelines referenced in subparagraph [(F)] (D) 45 of this paragraph. 46 [(F)] (D) The superintendent, in consultation with the commissioner of 47 health, shall promulgate regulations which shall stipulate the guide- 48 lines and standards which shall be used in carrying out the provisions 49 of this paragraph, which shall include: 50 (i) [The determination of "infertility" in accordance with the stand-51ards and guidelines established and adopted by the American College of52Obstetricians and Gynecologists and the American Society for Reproduc-53tive Medicine;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 byA. 2817 5 1 the American College of Obstetricians and Gynecologists and the American 2 Society for Reproductive Medicine; 3 [(iii)] (ii) The identification of the required training, experience 4 and other standards for health care providers for the provision of 5 procedures 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)] (iii) The determination of appropriate medical candidates by 10 the treating physician in accordance with the standards and guidelines 11 established and adopted by the American College of Obstetricians and 12 Gynecologists and/or the American Society for Reproductive Medicine. 13 § 6. This act shall take effect on the first day of January next 14 succeeding the date on which it shall have become a law and shall apply 15 to all policies issued, renewed, altered or modified on or after such 16 date.