NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2817
SPONSOR: Simotas (MS) TITLE OF BILL:
An act to amend the insurance law, in relation to insurance coverage of
in vitro fertilization and other fertility preservation treatments
PURPOSE:
To require health insurance policies to provide coverage for in-vitro
fertilization
SUMMARY OF PROVISIONS:
Sections one of the bill amends section 3216 of the Ins. L. to require
that individual policies provide coverage for (1) in-vitro fertilization
used in the treatment of infertility, and (2) fertility preservation
services, regardless of length or quality of life, medical dependency,
disability, or personal characteristics.
Section two of the bill would amend section 3221 of the Ins. L. to
require that group policies provide coverage for (1) in-vitro fertiliza-
tion used in the treatment of infertility, and (2) fertility preserva-
tion services, regardless of length or quality of life, medical depend-
ency, disability, or personal characteristics.
Section three of the bill would amend Section 4303 of the Ins. L. to
require that policies issued by a medical expense indemnity corporation,
hospital service corporation, or health service corporation provide
coverage for (1) in-vitro fertilization used in the treatment of infer-
tility, and (2) fertility preservation services, regardless of length or
quality of life, medical dependency, disability, or personal character-
istics.
Section four of the bill amends subparagraph c of paragraph 6 of
subsection k of section 3221 of the insurance law to repeal discrimina-
tory age restrictions and provisions exempting in-vitro fertilization,
gamete intrafallopian tube transfers or zygote intrafallopian tube
transfers from coverage requirements for group or blanket accident and
health insurance plans.
Section five of the bill amends paragraph 3 of subsection S of section
4303 of the insurance law to apply the same requirements to benefits
provided by a medical expense indemnity corporation, hospital service
corporation, or health service corporation.
Section six of the bill provides the effective date of the bill.
EXISTING LAW:
Currently, New York requires coverage of some infertility treatments in
the commercial market place for women between the ages of 21 and 44,
However, current law does not require coverage for in-vitro fertiliza-
tion (IVF), or fertility preservation.
JUSTIFICATION:
It is estimated that one in eight individuals or couples have trouble
getting pregnant or sustaining pregnancy. While family building options
do exist for people affected by infertility, these options are often
cost-prohibitive, with 67% of individuals or couples reporting spending
at least $10,000. High costs present a major bather to medical treat-
ment; nearly half of all individuals affected by infertility lack insur-
ance coverage necessary for fertility treatment.
The rapid advancement of medical technology in the past 20 years estab-
lished in-vitro fertilization as the safest and most effective form of
fertility treatment. Compared to treatments presently covered under New
York state law, such as ovulation induction or ovulation enhancement,
in-vitro fertilization results in fewer pregnancy complications and
high-risk births. Several states, including Massachusetts, Rhode Island,
New Jersey, Maryland, Illinois, Arkansas, Hawaii, and Connecticut, have
already enacted laws requiring insurers to cover in-vitro fertilization.
These states experience lower rates of multiple births and associated
neo-natal and pediatric care costs. This legislation has the potential
to save New York millions of dollars in long-term health care costs,
since patients would no longer be forced to rely on higher risk medical
procedures.
Under current law, New York requires insurers to provide coverage for
some diagnostic and treatment procedures for infertility. However, these
requirements do not extend to in-vitro fertilization. This bill would
update the existing law to reflect advances in modern medical technolo-
gy, requiring coverage for in-vitro fertilization to expand access to
this procedure and enable patients and their physicians to choose the
best course of treatment for infertility. It would also provide a clear
definition of infertility and ensure that cancer patients whose ability
to conceive has been compromised by chemotherapy, radiation, surgery, or
other medical procedures have fair access to fertility preservation
methods. Lastly, this bill includes anti-discrimination protections for
patients eligible for in-vitro fertilization, as required by the Afford-
able Care Act.
LEGISLATIVE HISTORY:
2017-18: A2646A
2015-16: A10137
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act would take effect on the first day of January next succeeding
the date on which it shall have become a law and shall apply to all
policies issued, renewed, altered or modified on or after such date.
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.
LBD01402-02-9
A. 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 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. 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 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. 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.
