Bill Text: NY S08441 | 2017-2018 | General Assembly | Amended


Bill Title: Relates to insurance coverage up to fifty thousand dollars for women ages 21 to 44 for in vitro fertilization and other fertility preservation treatments.

Spectrum: Partisan Bill (Republican 10-0)

Status: (Engrossed - Dead) 2018-06-20 - referred to insurance [S08441 Detail]

Download: New_York-2017-S08441-Amended.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                         8441--B
                    IN SENATE
                                       May 7, 2018
                                       ___________
        Introduced   by   Sens.  PHILLIPS,  HELMING,  AKSHAR,  BONACIC,  LITTLE,
          MARCHIONE, O'MARA, YOUNG -- read twice and ordered printed,  and  when
          printed  to  be  committed  to the Committee on Insurance -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee  --  committee  discharged,  bill  amended,  ordered
          reprinted as amended and recommitted to said committee
        AN  ACT to amend the insurance law, in relation to insurance coverage of
          in vitro fertilization and other  fertility  preservation  treatments;
          and  to  amend  part  K of chapter 82 of the laws of 2002 amending the
          insurance law and the public health law relating to coverage  for  the
          diagnosis  and  treatment  of  infertility,  in relation to grants for
          infertility services
          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 a
     6  maximum lifetime limit of fifty thousand dollars 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) For the purposes of subparagraph (C) of this paragraph:
    12    (i)  "Infertility"  means  a condition or disease characterized by the
    13  incapacity to impregnate another person or to conceive, as diagnosed  or
    14  determined  (I)  by  a  physician  licensed to practice medicine in this
    15  state, or (II) by the failure to establish a  clinical  pregnancy  after
    16  twelve  months  of regular, unprotected sexual intercourse, or after six
    17  months of regular, unprotected sexual  intercourse  in  the  case  of  a
    18  female over age thirty-five.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04562-13-8

        S. 8441--B                          2
     1    (ii)  "Iatrogenic  infertility"  means  an  impairment of fertility by
     2  surgery, radiation, chemotherapy or other  medical  treatment  affecting
     3  reproductive organs or processes.
     4    (iii)  Coverage  for  prescription drugs necessary as part of in vitro
     5  fertilization or standard fertility preservation services is only avail-
     6  able where the  policy  otherwise  provides  coverage  for  prescription
     7  drugs.
     8    (iv)  Notwithstanding  any other provision of law, a policy may impose
     9  cost sharing, deductibles or coinsurance  obligations  that  exceed  the
    10  dollar  amount  of  cost sharing, deductibles or coinsurance obligations
    11  for non-preferred brand name drugs or their equivalent.
    12    (E) For services provided pursuant to subparagraph (C) of  this  para-
    13  graph, policies may:
    14    (i)  Require  that services be performed by clinics or medical centers
    15  that conform to guidelines issued by the American Society for  Reproduc-
    16  tive Medicine or the American College of Obstetricians and Gynecologists
    17  (ACOG);
    18    (ii)  Require, notwithstanding network adequacy requirements, that all
    19  services be performed at designated providers identified by the  insurer
    20  as  meeting  specified  credentialing  and  quality  standards and which
    21  participate in the insurer's provider network;
    22    (iii) Limit coverage for in vitro fertilization to  those  individuals
    23  who  have  been  unable  to  conceive or produce conception through less
    24  expensive and  medically  viable  infertility  treatment  or  procedures
    25  covered under such policy. Nothing in this subsection shall be construed
    26  to  deny  the  coverage  required  by this section to any individual who
    27  foregoes a particular infertility treatment or procedure if the individ-
    28  ual's physician determines that such treatment or procedure is likely to
    29  be unsuccessful;
    30    (iv) For purposes of calculating the lifetime limit,  require  disclo-
    31  sure by the individual seeking such coverage to such individual's exist-
    32  ing  health  insurance  carrier of any previous infertility treatment or
    33  procedures for which such individual received coverage under a different
    34  health insurance policy issued by the same insurer or by another  insur-
    35  er; or
    36    (v)  Limit  coverage  related  to  in  vitro fertilization services to
    37  persons whose ages range from twenty-one through forty-four years.
    38    § 2. Paragraph 6 of subsection (k) of section 3221  of  the  insurance
    39  law is amended by adding four new subparagraphs (E), (F), (G) and (H) to
    40  read as follows:
    41    (E)  Every group policy delivered or issued for delivery in this state
    42  that provides hospital, surgical or medical  coverage  shall  provide  a
    43  maximum lifetime limit of fifty thousand dollars of coverage for:
    44    (i) in vitro fertilization used in the treatment of infertility; and
    45    (ii) standard fertility preservation services when a necessary medical
    46  treatment  may  directly or indirectly cause iatrogenic infertility to a
    47  covered person.
    48    (F) For the purposes of subparagraph (E) of this paragraph:
    49    (i) "Infertility" means a condition or disease  characterized  by  the
    50  incapacity  to impregnate another person or to conceive, as diagnosed or
    51  determined (I) by a physician licensed  to  practice  medicine  in  this
    52  state,  or  (II)  by the failure to establish a clinical pregnancy after
    53  twelve months of regular, unprotected sexual intercourse, or  after  six
    54  months  of  regular,  unprotected  sexual  intercourse  in the case of a
    55  female over age thirty-five.

        S. 8441--B                          3
     1    (ii) "Iatrogenic infertility" means  an  impairment  of  fertility  by
     2  surgery,  radiation,  chemotherapy  or other medical treatment affecting
     3  reproductive organs or processes.
     4    (iii)  Coverage  for  prescription drugs necessary as part of in vitro
     5  fertilization or standard fertility preservation services is only avail-
     6  able where the  policy  otherwise  provides  coverage  for  prescription
     7  drugs.
     8    (iv)  Notwithstanding  any other provision of law, a policy may impose
     9  cost sharing, deductibles or coinsurance  obligations  that  exceed  the
    10  dollar  amount  of  cost sharing, deductibles or coinsurance obligations
    11  for non-preferred brand name drugs or their equivalent.
    12    (G) Notwithstanding any other provision of this  subsection,  a  reli-
    13  gious  employer  may  request  a  contract without coverage for in vitro
    14  fertilization used in the treatment of infertility and standard fertili-
    15  ty preservation services that are contrary to the  religious  employer's
    16  religious tenets. If so requested, such contract shall be provided with-
    17  out coverage for services.
    18    (i) For purposes of this subsection, a "religious employer" is a group
    19  or entity for which each of the following is true:
    20    (I) The inculcation of religious values is the purpose of the group or
    21  entity.
    22    (II) The group or entity primarily employs persons who share the reli-
    23  gious tenets of the group or entity.
    24    (III) The group or entity serves primarily persons who share the reli-
    25  gious tenets of the group or entity.
    26    (IV)  The  group or entity is a nonprofit organization as described in
    27  Section 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986,  as
    28  amended.
    29    (ii)  Every  religious  employer  that  invokes the exemption provided
    30  under this subparagraph shall  provide  written  notice  to  prospective
    31  enrollees  prior  to  enrollment with the plan, listing the treatment of
    32  infertility and standard fertility preservation  services  the  employer
    33  refuses to cover for religious reasons.
    34    (H)  For  services provided pursuant to subparagraph (E) of this para-
    35  graph, policies may:
    36    (i) Require that services be performed by clinics or  medical  centers
    37  that  conform to guidelines issued by the American Society for Reproduc-
    38  tive Medicine or the American College of Obstetricians and Gynecologists
    39  (ACOG);
    40    (ii) Require, notwithstanding network adequacy requirements, that  all
    41  services  be performed at designated providers identified by the insurer
    42  as meeting specified  credentialing  and  quality  standards  and  which
    43  participate in the insurer's provider network;
    44    (iii)  Limit  coverage for in vitro fertilization to those individuals
    45  who have been unable to conceive  or  produce  conception  through  less
    46  expensive  and  medically  viable  infertility  treatment  or procedures
    47  covered under such policy. Nothing in this subsection shall be construed
    48  to deny the coverage required by this  section  to  any  individual  who
    49  foregoes a particular infertility treatment or procedure if the individ-
    50  ual's physician determines that such treatment or procedure is likely to
    51  be unsuccessful;
    52    (iv)  For  purposes of calculating the lifetime limit, require disclo-
    53  sure by the individual seeking such coverage to such individual's exist-
    54  ing health insurance carrier of any previous  infertility  treatment  or
    55  procedures for which such individual received coverage under a different

        S. 8441--B                          4
     1  health  insurance policy issued by the same insurer or by another insur-
     2  er; or
     3    (v)  Limit  coverage  related  to  in  vitro fertilization services to
     4  persons whose ages range from twenty-one through forty-four years.
     5    § 3. Subsection (s) of section 4303 of the insurance law,  as  amended
     6  by  section 2 of part F of chapter 82 of the laws of 2002, is amended by
     7  adding four new paragraphs 5, 6, 7 and 8 to read as follows:
     8    (5) Every contract issued by a medical expense indemnity  corporation,
     9  hospital  service corporation or health service corporation for delivery
    10  in this state that provides hospital, surgical or medical coverage shall
    11  provide a maximum lifetime limit of fifty thousand dollars  of  coverage
    12  for:
    13    (A) in vitro fertilization used in the treatment of infertility; and
    14    (B)  standard fertility preservation services when a necessary medical
    15  treatment may directly or indirectly cause iatrogenic infertility  to  a
    16  covered person.
    17    (6) For the purposes of paragraph five of this subsection:
    18    (A)  "Infertility"  means  a condition or disease characterized by the
    19  incapacity to impregnate another person or to conceive, as diagnosed  or
    20  determined  (i)  by  a  physician  licensed to practice medicine in this
    21  state, or (ii) by the failure to establish a  clinical  pregnancy  after
    22  twelve  months  of regular, unprotected sexual intercourse, or after six
    23  months of regular, unprotected sexual  intercourse  in  the  case  of  a
    24  female over age thirty-five.
    25    (B)  "Iatrogenic  infertility"  means  an  impairment  of fertility by
    26  surgery, radiation, chemotherapy or other  medical  treatment  affecting
    27  reproductive organs or processes.
    28    (C)  Coverage  for  prescription  drugs  necessary as part of in vitro
    29  fertilization or standard fertility preservation services is only avail-
    30  able where the  policy  otherwise  provides  coverage  for  prescription
    31  drugs.
    32    (D)  Notwithstanding  any  other provision of law, a policy may impose
    33  cost sharing, deductibles or coinsurance  obligations  that  exceed  the
    34  dollar  amount  of  cost sharing, deductibles or coinsurance obligations
    35  for non-preferred brand name drugs or their equivalent.
    36    (7) Notwithstanding any other provision of this  subsection,  a  reli-
    37  gious  employer  may  request  a  contract without coverage for in vitro
    38  fertilization used in the treatment of infertility and standard fertili-
    39  ty preservation services that are contrary to the  religious  employer's
    40  religious tenets. If so requested, such contract shall be provided with-
    41  out coverage for services.
    42    (A) For purposes of this subsection, a "religious employer" is a group
    43  or entity for which each of the following is true:
    44    (i) The inculcation of religious values is the purpose of the group or
    45  entity.
    46    (ii) The group or entity primarily employs persons who share the reli-
    47  gious tenets of the group or entity.
    48    (iii) The group or entity serves primarily persons who share the reli-
    49  gious tenets of the group or entity.
    50    (iv)  The  group or entity is a nonprofit organization as described in
    51  Section 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986,  as
    52  amended.
    53    (B) Every religious employer that invokes the exemption provided under
    54  this  paragraph  shall  provide  written notice to prospective enrollees
    55  prior to enrollment with the plan, listing the treatment of  infertility

        S. 8441--B                          5
     1  and  standard  fertility  preservation  services the employer refuses to
     2  cover for religious reasons.
     3    (8)   For  services  provided  pursuant  to  paragraph  five  of  this
     4  subsection, policies may:
     5    (A) Require that services be performed by clinics or  medical  centers
     6  that  conform to guidelines issued by the American Society for Reproduc-
     7  tive Medicine or the American College of Obstetricians and Gynecologists
     8  (ACOG);
     9    (B) Require, notwithstanding network adequacy requirements,  that  all
    10  services  be performed at designated providers identified by the insurer
    11  as meeting specified  credentialing  and  quality  standards  and  which
    12  participate in the insurer's provider network;
    13    (C) Limit coverage for in vitro fertilization to those individuals who
    14  have  been  unable to conceive or produce conception through less expen-
    15  sive and medically viable infertility treatment  or  procedures  covered
    16  under such policy. Nothing in this subsection shall be construed to deny
    17  the  coverage  required by this section to any individual who foregoes a
    18  particular infertility treatment or procedure if the individual's physi-
    19  cian determines that such treatment or procedure is likely to be  unsuc-
    20  cessful;
    21    (D) For purposes of calculating the lifetime limit, require disclosure
    22  by  the  individual  seeking such coverage to such individual's existing
    23  health insurance carrier of any previous infertility treatment or proce-
    24  dures for which such individual  received  coverage  under  a  different
    25  health  insurance policy issued by the same insurer or by another insur-
    26  er; or
    27    (E) Limit coverage related  to  in  vitro  fertilization  services  to
    28  persons whose ages range from twenty-one through forty-four years.
    29    § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221
    30  of the insurance law, as amended by section 1 of part K of chapter 82 of
    31  the laws of 2002, is amended to read as follows:
    32    (C)   Coverage  of  diagnostic  and  treatment  procedures,  including
    33  prescription drugs, used in the diagnosis and treatment  of  infertility
    34  as  required  by  subparagraphs  (A)  and (B) of this paragraph shall be
    35  provided in accordance with the provisions of this subparagraph.
    36    (i) Coverage shall be provided for persons whose ages range from twen-
    37  ty-one through forty-four years,  provided  that  nothing  herein  shall
    38  preclude  the  provision  of  coverage  to persons whose age is below or
    39  above such range.
    40    (ii) Diagnosis and treatment of infertility  shall  be  prescribed  as
    41  part  of  a  physician's  overall  plan  of care and consistent with the
    42  guidelines for coverage as referenced in this subparagraph.
    43    (iii) Coverage may be subject to co-payments, coinsurance and  deduct-
    44  ibles  as  may  be  deemed  appropriate by the superintendent and as are
    45  consistent with those established for  other  benefits  within  a  given
    46  policy.
    47    (iv)  [Coverage  shall  be  limited to those individuals who have been
    48  previously covered under the policy for a period of not less than twelve
    49  months, provided that for the purposes of this subparagraph  "period  of
    50  not  less  than  twelve  months" shall be determined by calculating such
    51  time from either the date the insured was first covered under the exist-
    52  ing policy or from the date the insured was first covered by a previous-
    53  ly in-force converted policy, whichever is earlier.
    54    (v)] Coverage shall not be  required  to  include  the  diagnosis  and
    55  treatment  of  infertility  in connection with: (I) [in vitro fertiliza-
    56  tion,] gamete intrafallopian tube  transfers  or  zygote  intrafallopian

        S. 8441--B                          6
     1  tube  transfers; (II) the reversal of elective sterilizations; (III) sex
     2  change procedures; (IV) cloning; or (V) medical or surgical services  or
     3  procedures  that  are deemed to be experimental in accordance with clin-
     4  ical guidelines referenced in clause [(vi)] (v) of this subparagraph.
     5    [(vi)]  (v)  The superintendent, in consultation with the commissioner
     6  of health, shall promulgate regulations which shall stipulate the guide-
     7  lines and standards which shall be used in carrying out  the  provisions
     8  of this subparagraph, which shall include:
     9    (I)  The  determination of "infertility" in accordance with the stand-
    10  ards and guidelines established and adopted by the American  College  of
    11  Obstetricians  and  Gynecologists and the American Society for Reproduc-
    12  tive Medicine;
    13    (II) The identification of experimental procedures and treatments  not
    14  covered  for  the  diagnosis  and treatment of infertility determined in
    15  accordance with the standards and guidelines established and adopted  by
    16  the American College of Obstetricians and Gynecologists and the American
    17  Society for Reproductive Medicine;
    18    (III)  The  identification  of  the  required training, experience and
    19  other standards for health care providers for the  provision  of  proce-
    20  dures  and  treatments  for  the  diagnosis and treatment of infertility
    21  determined in accordance with the standards and  guidelines  established
    22  and  adopted  by the American College of Obstetricians and Gynecologists
    23  and the American Society for Reproductive Medicine; and
    24    (IV) The determination of appropriate medical candidates by the treat-
    25  ing physician in accordance with the  standards  and  guidelines  estab-
    26  lished and adopted by the American College of Obstetricians and Gynecol-
    27  ogists and/or the American Society for Reproductive Medicine.
    28    §  5.  Paragraph  3 of subsection (s) of section 4303 of the insurance
    29  law, as amended by section 2 of part K of chapter  82  of  the  laws  of
    30  2002, is amended to read as follows:
    31    (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
    32  prescription drugs used in the diagnosis and treatment of infertility as
    33  required by paragraphs one and two of this subsection shall be  provided
    34  in accordance with this paragraph.
    35    (A) Coverage shall be provided for persons whose ages range from twen-
    36  ty-one  through  forty-four  years,  provided  that nothing herein shall
    37  preclude the provision of coverage to persons  whose  age  is  below  or
    38  above such range.
    39    (B) Diagnosis and treatment of infertility shall be prescribed as part
    40  of a physician's overall plan of care and consistent with the guidelines
    41  for coverage as referenced in this paragraph.
    42    (C)  Coverage  may  be subject to co-payments, coinsurance and deduct-
    43  ibles as may be deemed appropriate by  the  superintendent  and  as  are
    44  consistent  with  those  established  for  other benefits within a given
    45  policy.
    46    [(D) Coverage shall be limited to  those  individuals  who  have  been
    47  previously covered under the policy for a period of not less than twelve
    48  months,  provided that for the purposes of this paragraph "period of not
    49  less than twelve months" shall be determined by  calculating  such  time
    50  from  either  the  date the insured was first covered under the existing
    51  policy or from the date the insured was first covered  by  a  previously
    52  in-force converted policy, whichever is earlier.
    53    (E)]  (D)  Coverage shall not be required to include the diagnosis and
    54  treatment of infertility in connection with: (i)  [in  vitro  fertiliza-
    55  tion,]  gamete  intrafallopian  tube  transfers or zygote intrafallopian
    56  tube transfers; (ii) the reversal of elective sterilizations; (iii)  sex

        S. 8441--B                          7
     1  change  procedures; (iv) cloning; or (v) medical or surgical services or
     2  procedures that are deemed to be experimental in accordance  with  clin-
     3  ical guidelines referenced in subparagraph [(F)] (E) of this paragraph.
     4    [(F)] (E) The superintendent, in consultation with the commissioner of
     5  health,  shall  promulgate  regulations which shall stipulate the guide-
     6  lines and standards which shall be used in carrying out  the  provisions
     7  of this paragraph, which shall include:
     8    (i)  The  determination of "infertility" in accordance with the stand-
     9  ards and guidelines established and adopted by the American  College  of
    10  Obstetricians  and  Gynecologists and the American Society for Reproduc-
    11  tive Medicine;
    12    (ii) The identification of experimental procedures and treatments  not
    13  covered  for  the  diagnosis  and treatment of infertility determined in
    14  accordance with the standards and guidelines established and adopted  by
    15  the American College of Obstetricians and Gynecologists and the American
    16  Society for Reproductive Medicine;
    17    (iii)  The  identification  of  the  required training, experience and
    18  other standards for health care providers for the  provision  of  proce-
    19  dures  and  treatments  for  the  diagnosis and treatment of infertility
    20  determined in accordance with the standards and  guidelines  established
    21  and  adopted  by the American College of Obstetricians and Gynecologists
    22  and the American Society for Reproductive Medicine; and
    23    (iv) The determination of appropriate medical candidates by the treat-
    24  ing physician in accordance with the  standards  and  guidelines  estab-
    25  lished and adopted by the American College of Obstetricians and Gynecol-
    26  ogists and/or the American Society for Reproductive Medicine.
    27    §  6.  Section 4 of part K of chapter 82 of the laws of 2002, amending
    28  the insurance law and the public health law relating to coverage for the
    29  diagnosis and treatment of infertility, is amended to read as follows:
    30    § 4. The commissioner of health, subject to the availability of  funds
    31  pursuant  to  section 2807-v of the public health law, shall establish a
    32  program to provide grants to health care providers for  the  purpose  of
    33  improving  access to infertility services, treatments and procedures. At
    34  least one such provider shall be located in the city of New York and one
    35  such provider shall be located in an upstate region.
    36    Such program shall be targeted to assist individuals  in  meeting  the
    37  cost  of  infertility services not covered pursuant to sections 3221 and
    38  4303 of the insurance law as such sections are amended by  sections  one
    39  and  two  of  this  act  relating  to  expanded  coverage of infertility
    40  services. Services, treatments and procedures paid for pursuant  to  the
    41  grant  program  shall be limited to: (a) those who meet the criteria for
    42  such expanded coverage provided pursuant to the insurance  law  but  for
    43  whom  the  covered  services are not effective for treating infertility,
    44  and those who are unable to access coverage for the expanded  procedures
    45  enacted pursuant to a chapter of the laws of 2018; and (b) those who are
    46  not  enrolled  in  a commercial health care plan but who would otherwise
    47  meet the criteria of subdivision (a) of this section.  Services,  treat-
    48  ments  and  procedures  paid  for pursuant to the grant program shall be
    49  further limited to assisted reproductive technology utilizing  in  vitro
    50  fertilization and gamete intrafallopian tube transfer, and shall be made
    51  available only in accordance with standards, protocols and other parame-
    52  ters  as  shall  be established by the commissioner, which shall include
    53  but not be limited to ASRM and ACOG standards for the appropriateness of
    54  individuals, providers and treatments, and standards relating  to  cost-
    55  sharing  based  on income. Services, treatments and procedures under the
    56  grant program, except for those  specified  herein,  shall  not  include

        S. 8441--B                          8
     1  those  services, treatments and procedures explicitly excluded under the
     2  expanded coverage provided for  in  the  insurance  law  as  amended  by
     3  sections  one and two of this act.  Notwithstanding sections 112 and 163
     4  of  the  state finance law, grants provided pursuant to such program may
     5  be made without competitive bid or request for proposal.
     6    The commissioner of health shall  promote  public  awareness  of  this
     7  program.
     8    §  7.    The superintendent of financial services in consultation with
     9  the commissioner of health, shall reassess the coverage requirements  of
    10  this  act and regulations promulgated thereunder pursuant to a review of
    11  the comprehensive report funded pursuant to appropriation by chapter  50
    12  of the laws of 2018 and the request for quote number C000457.
    13    § 8. This act shall take effect January 1, 2020 and shall apply to all
    14  policies  issued,  renewed,  altered  or modified on or after such date;
    15  provided, however, that should this act be determined to  be  a  mandate
    16  pursuant to section 1311 (d)(3)(B) of the Patient Protection and Afford-
    17  able  Care Act, then this act shall not apply to coverage offered in the
    18  individual and small group market unless the  state  appropriates  funds
    19  sufficient to cover the full cost of such coverage, as determined by the
    20  department  of financial services and independently verified by an inde-
    21  pendent actuarial firm certified by the American academy  of  actuaries.
    22  In  addition,  the  superintendent  of  financial  services shall permit
    23  insurers and other organizations subject to  this  act  to  establish  a
    24  minimum  factor  attributable  to  the services covered pursuant to this
    25  chapter that may be incorporated into rates  for  large  group  policies
    26  issued  on  or  after January 1, 2020.   Provided further, however, that
    27  should this act be determined not to be a mandate  pursuant  to  section
    28  1311(d)(3)(B)  of  the  Patient Protection and Affordable Care Act, then
    29  the superintendent of financial services shall include in  the  approved
    30  small  group  and  individual rates a factor attributable to the cost of
    31  services covered pursuant to this chapter and consistent with the  actu-
    32  arial  cost,  as projected by the applicant, of such coverage that shall
    33  be incorporated into rates for policies issued on or  after  January  1,
    34  2020.
feedback