Bill Text: NY A06177 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.

Spectrum: Partisan Bill (Democrat 13-0)

Status: (Introduced) 2024-01-03 - referred to insurance [A06177 Detail]

Download: New_York-2023-A06177-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6177

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                      April 3, 2023
                                       ___________

        Introduced  by  M.  of  A.  PAULIN,  BURDICK,  DINOWITZ, GONZALEZ-ROJAS,
          SEAWRIGHT, SILLITTI, SIMONE -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the insurance law, in  relation  to  the  definition  of
          infertility and health insurance coverage for in-vitro fertilization

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. This act shall be known and may be cited as "The Equity  in
     2  Fertility Treatment Act".
     3    §  2.  Items  (v)  and  (vii)  of  subparagraph  (C) of paragraph 6 of
     4  subsection (k) of section 3221 of  the  insurance  law,  as  amended  by
     5  section  1  of  part L of chapter 57 of the laws of 2019, are amended to
     6  read as follows:
     7    (v)(I) For the purposes  of  this  paragraph,  "infertility"  means  a
     8  disease  or  condition  characterized  by  the  incapacity to impregnate
     9  another person or to conceive, defined by (a) the failure to establish a
    10  clinical pregnancy after twelve months of  regular,  unprotected  sexual
    11  intercourse  or  therapeutic  donor insemination, or after six months of
    12  regular, unprotected sexual intercourse or therapeutic  donor  insemina-
    13  tion  for  a  female  thirty-five  years of age or older; (b) a person's
    14  inability to reproduce either as a single individual or with their part-
    15  ner without medical intervention;  or  (c)  a  licensed  physician's  or
    16  osteopathic  physician's  findings based on a patient's medical, sexual,
    17  or reproductive history, age, physical findings, or diagnostic  testing.
    18  Earlier  evaluation  and treatment may be warranted based on an individ-
    19  ual's medical, sexual, or reproductive history [or], age, physical find-
    20  ings, or diagnostic testing.
    21    (II) For purposes of this paragraph, "iatrogenic infertility" means an
    22  impairment of fertility by surgery,  radiation,  chemotherapy  or  other
    23  medical treatment affecting reproductive organs or processes.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10106-02-3
        A. 6177                             2

     1    (vii)  Every  large  group  policy delivered or issued for delivery in
     2  this state that provides medical, major medical  or  similar  comprehen-
     3  sive-type   coverage  shall  provide  coverage  for  three  [cycles  of]
     4  completed oocyte retrievals and  in-vitro  fertilization  [used  in  the
     5  treatment  of infertility] with unlimited embryo transfers from fresh or
     6  frozen oocytes or embryos from a covered retrieval, in  accordance  with
     7  the  guidelines of the American Society for Reproductive Medicine, using
     8  single embryo transfer (SET) when recommended and medically  appropriate
     9  for  the  treatment  of  infertility.  Coverage may be subject to annual
    10  deductibles and coinsurance, including  copayments,  as  may  be  deemed
    11  appropriate  by  the  superintendent  and  as  are consistent with those
    12  established for other benefits within a given policy. [For  purposes  of
    13  this  item,  a  "cycle"  is  defined as either all treatment that starts
    14  when: preparatory medications are administered for  ovarian  stimulation
    15  for  oocyte  retrieval with the intent of undergoing in-vitro fertiliza-
    16  tion using a fresh embryo transfer; or medications are administered  for
    17  endometrial  preparation with the intent of undergoing in-vitro fertili-
    18  zation using a frozen embryo transfer.]
    19    § 3. Subparagraphs (E) and (G) of paragraph 3  of  subsection  (s)  of
    20  section  4303 of the insurance law, as amended by section 2 of part L of
    21  chapter 57 of the laws of 2019, are amended to read as follows:
    22    (E)(i) For the purposes of  this  subsection,  "infertility"  means  a
    23  disease  or  condition  characterized  by  the  incapacity to impregnate
    24  another person or to conceive, defined by (a) the failure to establish a
    25  clinical pregnancy after twelve months of  regular,  unprotected  sexual
    26  intercourse  or  therapeutic  donor insemination, or after six months of
    27  regular, unprotected sexual intercourse or therapeutic  donor  insemina-
    28  tion  for  a  female  thirty-five  years of age or older; (b) a person's
    29  inability to reproduce either as a single individual or with their part-
    30  ner without medical intervention;  or  (c)  a  licensed  physician's  or
    31  osteopathic  physician's  findings based on a patient's medical, sexual,
    32  or reproductive history, age, physical findings, or diagnostic  testing.
    33  Earlier  evaluation  and treatment may be warranted based on an individ-
    34  ual's medical history or physical findings.
    35    (ii) For purposes of this subsection, "iatrogenic  infertility"  means
    36  an  impairment of fertility by surgery, radiation, chemotherapy or other
    37  medical treatment affecting reproductive organs or processes.
    38    (G) Every large group contract that provides medical, major medical or
    39  similar comprehensive-type coverage shall  provide  coverage  for  three
    40  [cycles of] completed oocyte retrievals and in-vitro fertilization [used
    41  in  the  treatment  of infertility] with unlimited embryo transfers from
    42  fresh or frozen oocytes or embryos from a covered retrieval, in  accord-
    43  ance  with the guidelines of the American Society for Reproductive Medi-
    44  cine, using single embryo transfer (SET) when recommended and  medically
    45  appropriate  for  the treatment of infertility.  Coverage may be subject
    46  to annual deductibles and coinsurance, including copayments, as  may  be
    47  deemed  appropriate  by  the  superintendent  and as are consistent with
    48  those established for other  benefits  within  a  given  contract.  [For
    49  purposes of this subparagraph, a "cycle" is defined as either all treat-
    50  ment  that  starts  when:  preparatory  medications are administered for
    51  ovarian stimulation for oocyte retrieval with the intent  of  undergoing
    52  in-vitro fertilization using a fresh embryo transfer; or medications are
    53  administered  for  endometrial preparation with the intent of undergoing
    54  in-vitro fertilization using a frozen embryo transfer.]
    55    § 4. This act shall take effect immediately.