Bill Text: NJ A1124 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires small employer health insurance carriers to offer coverage for treatment of infertility.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A1124 Detail]
Download: New_Jersey-2010-A1124-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblywoman ELEASE EVANS
District 35 (Bergen and Passaic)
Co-Sponsored by:
Assemblyman Prieto, Assemblywoman Tucker, Assemblyman Chiappone, Assemblywoman Rodriguez and Assemblyman Green
SYNOPSIS
Requires small employer health insurance carriers to offer coverage for treatment of infertility.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning coverage for treatment of infertility and supplementing P.L.1992, c.162 (C.17B:27A-17 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State, on or after the effective date of this act, shall offer a benefit rider to provide benefits to any person covered thereunder for medically necessary expenses incurred in the diagnosis and treatment of infertility as provided pursuant to this section. The benefit rider shall include, but is not limited to, coverage for the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The carrier may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.
For purposes of this section, "infertility" means the disease or condition that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse if the female partner is under 35 years of age, or one year of unprotected intercourse if the female partner is 35 years of age or older or one of the partners is considered medically sterile; or carry a pregnancy to live birth.
The benefits shall be provided to the same extent as for other pregnancy-related procedures under the health benefits plan, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the health benefits plan.
b. The benefit rider shall be offered in accordance with the provisions of subsection i. of section 3 of P.L.1992, c.162 (C.17B:27A-19). The benefit rider shall include any benefits as described in subsection a. of this section that are not currently provided under a small employer health benefits plan, and shall not be offered in such a manner as to decrease the benefits already provided to a covered person under a small employer health benefits plan.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
2. This act shall take effect on the 90th day after enactment and shall apply to all contacts and policies delivered, issued, executed or renewed on or after that date.
STATEMENT
This bill requires a small employer health benefits plan to offer coverage, as a benefit rider to the small employer standard health benefits plans, for medically necessary expenses incurred in the diagnosis and treatment of infertility. The coverage would be based on the fertility treatment coverage that is mandated for groups of more than 50 persons pursuant to P.L.2001, c.236 (C.17:48-6x et al.).
The bill provides that the coverage under the benefit rider shall include, but not be limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. Under the bill, the health insurance carrier may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer is limited to a covered person who: has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; has not reached the limit of four completed egg retrievals; and is 45 years of age or younger.
The bill defines "infertility" as the disease or condition that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse if the female partner is under 35 years of age, or one year of unprotected intercourse if the female partner is 35 years of age or older or one of the partners is considered medically sterile; or carry a pregnancy to live birth.
The bill requires that the benefits shall be provided to the same extent as for other pregnancy-related procedures under the health benefits plan, except that the services provided for in this bill must be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
