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A02646 Summary:

BILL NOA02646A
 
SAME ASSAME AS S03148-A
 
SPONSORSimotas
 
COSPNSRQuart, Bronson, Solages, Braunstein, Bichotte, Steck, Seawright, Simon, Brindisi, Paulin, Barrett, Hevesi, McDonald, Lavine, Cymbrowitz, Mosley, Buchwald, Morelle, Dinowitz, Rozic, Sepulveda, Rosenthal L, Murray, Otis, Lifton, Jean-Pierre, Pellegrino, Wright, Weprin, Curran, Espinal
 
MLTSPNSREnglebright, Lentol
 
Amd 3216, 3221 & 4303, Ins L
 
Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.
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A02646 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2646--A
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 20, 2017
                                       ___________
 
        Introduced  by  M.  of  A. SIMOTAS, QUART, BRONSON, SOLAGES, BRAUNSTEIN,
          BICHOTTE, STECK, SEAWRIGHT, SIMON, BRINDISI, PAULIN, BARRETT,  HEVESI,
          McDONALD,  MOYA, LAVINE, CYMBROWITZ, MOSLEY, BUCHWALD, MORELLE, DINOW-
          ITZ -- Multi-Sponsored by -- M. of A. ENGLEBRIGHT, LENTOL -- read once
          and referred to the Committee on Insurance  --  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
 
          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.
                                                                   LBD04562-03-7

        A. 2646--A                          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 F 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. 2646--A                          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  from
    20  twenty-one  through forty-four years, provided that nothing herein shall
    21  preclude the provision of coverage to persons  whose  age  is  below  or
    22  above 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  been
    31  previously covered under the policy for a period of not less than twelve
    32  months,  provided  that for the purposes of this subparagraph "period of
    33  not less than twelve months" shall be  determined  by  calculating  such
    34  time from either the date the insured was first covered under the exist-
    35  ing policy or from the date the insured was first covered by a previous-
    36  ly 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-
    39  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    40  transfers; (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-
    50  ards  and  guidelines established and adopted by the American College of
    51  Obstetricians and Gynecologists and the American Society  for  Reproduc-
    52  tive 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  by

        A. 2646--A                          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  from
    21  twenty-one  through forty-four years, provided that nothing herein shall
    22  preclude the provision of coverage to persons  whose  age  is  below  or
    23  above 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  been
    32  previously covered under the policy for a period of not less than twelve
    33  months,  provided that for the purposes of this paragraph "period of not
    34  less than twelve months" shall be determined by  calculating  such  time
    35  from  either  the  date the insured was first covered under the existing
    36  policy or from the date the insured was first covered  by  a  previously
    37  in-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-
    40  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    41  transfers;  (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-
    51  ards  and  guidelines established and adopted by the American College of
    52  Obstetricians and Gynecologists and the American Society  for  Reproduc-
    53  tive 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  by

        A. 2646--A                          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.
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