Bill Text: NY S09535 | 2023-2024 | General Assembly | Introduced

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Bill Title: Expands insurance coverage for in vitro fertilization; includes coverage under individual policies; provides coverage for three complete oocyte retrievals and in vitro fertilization with unlimited embryo transfers.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-05-16 - REFERRED TO WOMEN'S ISSUES [S09535 Detail]

Download: New_York-2023-S09535-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          9535

                    IN SENATE

                                      May 16, 2024
                                       ___________

        Introduced  by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
          and when printed to be committed to the Committee on Women's Issues

        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.
    27  Coverage may be subject to annual deductibles and coinsurance, including

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD15362-01-4
        S. 9535                             2

     1  copayments, as may be deemed appropriate by the  superintendent  and  as
     2  are  consistent with those established for other benefits within a given
     3  contract. [For purposes of this subparagraph, a "cycle"  is  defined  as
     4  either  all  treatment  that  starts  when:  preparatory medications are
     5  administered for ovarian  stimulation  for  oocyte  retrieval  with  the
     6  intent  of undergoing in-vitro fertilization using a fresh embryo trans-
     7  fer; or medications are administered for  endometrial  preparation  with
     8  the  intent  of  undergoing in-vitro fertilization using a frozen embryo
     9  transfer.]
    10    § 3. Paragraph 13 of subsection (i) of section 3216 of  the  insurance
    11  law, as added by chapter 897 of the laws of 1990 and renumbered by chap-
    12  ter  131  of the laws of 1992 and subparagraph (C) as added by section 3
    13  of part L of chapter 57 of the laws of  2019,  is  amended  to  read  as
    14  follows:
    15    (13)  (A) Every policy which provides coverage for hospital care shall
    16  not exclude coverage for hospital care for diagnosis  and  treatment  of
    17  correctable  medical  conditions  otherwise covered by the policy solely
    18  because the  medical  condition  results  in  infertility[.];  provided,
    19  however that:
    20    (i)  subject  to the provisions of subparagraph (C) of this paragraph,
    21  in no case shall such coverage exclude surgical  or  medical  procedures
    22  provided as part of such hospital care which would correct malformation,
    23  disease or dysfunction resulting in infertility; and
    24    (ii)  provided,  further  however,  that  subject to the provisions of
    25  subparagraph (C) of this paragraph,  in  no  case  shall  such  coverage
    26  exclude  diagnostic tests and procedures provided as part of such hospi-
    27  tal care that are necessary to determine infertility or that are  neces-
    28  sary   in   connection  with  any  surgical  or  medical  treatments  or
    29  prescription drug coverage provided pursuant to this paragraph,  includ-
    30  ing such diagnostic tests and procedures as hysterosalpingogram, hyster-
    31  oscopy,  endometrial  biopsy, laparoscopy, sono-hysterogram, post coital
    32  tests, testis biopsy, semen analysis, blood tests and ultrasound; and
    33    (iii) provided, further however,  every  such  policy  which  provides
    34  coverage  for  prescription  drugs  shall include, within such coverage,
    35  coverage for prescription drugs approved by the federal  Food  and  Drug
    36  Administration  for use in the diagnosis and treatment of infertility in
    37  accordance with subparagraph (C) of this paragraph.
    38    (B) Every policy which provides coverage for surgical and medical care
    39  shall not exclude coverage for surgical and medical care  for  diagnosis
    40  and treatment of correctable medical conditions otherwise covered by the
    41  policy  solely  because the medical condition results in infertility[.];
    42  provided, however that:
    43    (i) subject to the provisions of subparagraph (C) of  this  paragraph,
    44  in  no  case  shall such coverage exclude surgical or medical procedures
    45  which would correct malformation, disease or  dysfunction  resulting  in
    46  infertility; and
    47    (ii)  provided,  further  however,  that  subject to the provisions of
    48  subparagraph (C) of this paragraph,  in  no  case  shall  such  coverage
    49  exclude  diagnostic tests and procedures that are necessary to determine
    50  infertility or that are necessary in connection  with  any  surgical  or
    51  medical  treatments  or  prescription drug coverage provided pursuant to
    52  this paragraph,  including  such  diagnostic  tests  and  procedures  as
    53  hysterosalpingogram,   hysteroscopy,  endometrial  biopsy,  laparoscopy,
    54  sono-hysterogram, post coital  tests,  testis  biopsy,  semen  analysis,
    55  blood tests and ultrasound; and
        S. 9535                             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-
        S. 9535                             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.