Bill Text: NY S00719 | 2019-2020 | General Assembly | Introduced


Bill Title: Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.

Spectrum: Strong Partisan Bill (Democrat 13-1)

Status: (Introduced) 2019-01-09 - REFERRED TO INSURANCE [S00719 Detail]

Download: New_York-2019-S00719-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                           719
                               2019-2020 Regular Sessions
                    IN SENATE
                                       (Prefiled)
                                     January 9, 2019
                                       ___________
        Introduced  by  Sens.  SAVINO, BIAGGI -- read twice and ordered printed,
          and when printed to be committed 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-
    21  ation,  chemotherapy  or  other medical treatment affecting reproductive
    22  organs or processes.
    23    (E) No insurer providing coverage under this paragraph shall discrimi-
    24  nate based on a covered individual's expected length of life, present or
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01402-02-9

        S. 719                              2
     1  predicted disability, degree of medical dependency, perceived quality of
     2  life, or other health conditions, nor based on personal characteristics,
     3  including age, sex, sexual orientation, marital status or gender identi-
     4  ty.
     5    §  2.  Paragraph  6 of subsection (k) of section 3221 of the insurance
     6  law is amended by adding three new subparagraphs (E),  (F)  and  (G)  to
     7  read as follows:
     8    (E)  Every group policy delivered or issued for delivery in this state
     9  that provides hospital,  surgical  or  medical  coverage  shall  provide
    10  coverage for:
    11    (i) in vitro fertilization used in the treatment of infertility; and
    12    (ii) standard fertility preservation services when a necessary medical
    13  treatment  may  directly or indirectly cause iatrogenic infertility to a
    14  covered person.
    15    (F) (i) For the  purposes  of  subparagraph  (E)  of  this  paragraph,
    16  "infertility" means a disease or condition characterized by the incapac-
    17  ity  to impregnate another person or to conceive, as diagnosed or deter-
    18  mined (I) by a physician licensed to practice medicine in this state, or
    19  (II) by the failure to  establish  a  clinical  pregnancy  after  twelve
    20  months  of  regular, unprotected sexual intercourse, or after six months
    21  of regular, unprotected sexual intercourse in the case of a female thir-
    22  ty-five years of age or older.
    23    (ii) For the purposes of subparagraph (E) of this  paragraph,  "iatro-
    24  genic  infertility"  means  an impairment of fertility by surgery, radi-
    25  ation, chemotherapy or other medical  treatment  affecting  reproductive
    26  organs or processes.
    27    (G) No insurer providing coverage under this paragraph shall discrimi-
    28  nate based on a covered individual's expected length of life, present or
    29  predicted disability, degree of medical dependency, perceived quality of
    30  life, or other health conditions, nor based on personal characteristics,
    31  including age, sex, sexual orientation, marital status or gender identi-
    32  ty.
    33    §  3.  Subsection (s) of section 4303 of the insurance law, as amended
    34  by section 2 of part K of chapter 82 of the laws of 2002, is amended  by
    35  adding three new paragraphs (5), (6) and (7) to read as follows:
    36    (5)  Every contract issued by a medical expense indemnity corporation,
    37  hospital service corporation or health service corporation for  delivery
    38  in this state that provides hospital, surgical or medical coverage shall
    39  provide coverage for:
    40    (A) in vitro fertilization used in the treatment of infertility; and
    41    (B)  standard fertility preservation services when a necessary medical
    42  treatment may directly or indirectly cause iatrogenic infertility  to  a
    43  covered person.
    44    (6) (A) For the purposes of paragraph five of this subsection, "infer-
    45  tility"  means a disease or condition characterized by the incapacity to
    46  impregnate another person or to conceive, as diagnosed or determined (i)
    47  by a physician licensed to practice medicine in this state, or  (ii)  by
    48  the  failure  to  establish  a clinical pregnancy after twelve months of
    49  regular, unprotected sexual intercourse, or after six months of regular,
    50  unprotected sexual intercourse in the case of a female thirty-five years
    51  of age or older.
    52    (B) For the purposes of paragraph five of this subsection, "iatrogenic
    53  infertility" means an impairment of  fertility  by  surgery,  radiation,
    54  chemotherapy or other medical treatment affecting reproductive organs or
    55  processes.

        S. 719                              3
     1    (7)  No medical expense indemnity corporation, hospital service corpo-
     2  ration or health  service  corporation  providing  coverage  under  this
     3  subsection  shall  discriminate based on a covered individual's expected
     4  length of life, present  or  predicted  disability,  degree  of  medical
     5  dependency,  perceived  quality of life, or other health conditions, nor
     6  based on personal characteristics, including  age,  sex,  sexual  orien-
     7  tation, marital status or gender identity.
     8    § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221
     9  of the insurance law, as amended by section 1 of part K of chapter 82 of
    10  the laws of 2002, is amended to read as follows:
    11    (C)   Coverage  of  diagnostic  and  treatment  procedures,  including
    12  prescription drugs, used in the diagnosis and treatment  of  infertility
    13  as  required  by  subparagraphs  (A)  and (B) of this paragraph shall be
    14  provided in accordance with the provisions of this subparagraph.
    15    (i) [Coverage shall be provided for  persons  whose  ages  range  from
    16  twenty-one  through forty-four years, provided that nothing herein shall
    17  preclude the provision of coverage to persons  whose  age  is  below  or
    18  above such range.
    19    (ii)]  Diagnosis  and  treatment of infertility shall be prescribed as
    20  part of a physician's overall plan  of  care  and  consistent  with  the
    21  guidelines for coverage as referenced in this subparagraph.
    22    [(iii)]  (ii)  Coverage may be subject to co-payments, coinsurance and
    23  deductibles as may be deemed appropriate by the  superintendent  and  as
    24  are  consistent with those established for other benefits within a given
    25  policy.
    26    [(iv) Coverage shall be limited to those  individuals  who  have  been
    27  previously covered under the policy for a period of not less than twelve
    28  months,  provided  that for the purposes of this subparagraph "period of
    29  not less than twelve months" shall be  determined  by  calculating  such
    30  time from either the date the insured was first covered under the exist-
    31  ing policy or from the date the insured was first covered by a previous-
    32  ly in-force converted policy, whichever is earlier.
    33    (v)] (iii) Coverage shall not be required to include the diagnosis and
    34  treatment  of  infertility  in connection with: (I) [in vitro fertiliza-
    35  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    36  transfers; (II)] the reversal of elective sterilizations;  [(III)]  (II)
    37  sex  change  procedures;  [(IV)] (III) cloning; or [(V)] (IV) medical or
    38  surgical services or procedures that are deemed to  be  experimental  in
    39  accordance  with clinical guidelines referenced in clause [(vi)] (iv) of
    40  this subparagraph.
    41    [(vi)] (iv) The superintendent, in consultation with the  commissioner
    42  of health, shall promulgate regulations which shall stipulate the guide-
    43  lines  and  standards which shall be used in carrying out the provisions
    44  of this subparagraph, which shall include:
    45    (I) [The determination of "infertility" in accordance with the  stand-
    46  ards  and  guidelines established and adopted by the American College of
    47  Obstetricians and Gynecologists and the American Society  for  Reproduc-
    48  tive Medicine;
    49    (II)] The identification of experimental procedures and treatments not
    50  covered  for  the  diagnosis  and treatment of infertility determined in
    51  accordance with the standards and guidelines established and adopted  by
    52  the American College of Obstetricians and Gynecologists and the American
    53  Society for Reproductive Medicine;
    54    [(III)]  (II)  The identification of the required training, experience
    55  and other standards for health  care  providers  for  the  provision  of
    56  procedures and treatments for the diagnosis and treatment of infertility

        S. 719                              4
     1  determined  in  accordance with the standards and guidelines established
     2  and adopted by the American College of Obstetricians  and  Gynecologists
     3  and the American Society for Reproductive Medicine; and
     4    [(IV)]  (III)  The  determination of appropriate medical candidates by
     5  the treating physician in accordance with the standards  and  guidelines
     6  established  and  adopted  by  the American College of Obstetricians and
     7  Gynecologists and/or the American Society for Reproductive Medicine.
     8    § 5. Paragraph 3 of subsection (s) of section 4303  of  the  insurance
     9  law,  as  amended  by  section  2 of part K of chapter 82 of the laws of
    10  2002, is amended to read as follows:
    11    (3)  Coverage  of  diagnostic  and  treatment  procedures,   including
    12  prescription drugs used in the diagnosis and treatment of infertility as
    13  required  by paragraphs one and two of this subsection shall be provided
    14  in accordance with this paragraph.
    15    (A) [Coverage shall be provided for  persons  whose  ages  range  from
    16  twenty-one  through forty-four years, provided that nothing herein shall
    17  preclude the provision of coverage to persons  whose  age  is  below  or
    18  above such range.
    19    (B)]  Diagnosis  and  treatment  of infertility shall be prescribed as
    20  part of a physician's overall plan  of  care  and  consistent  with  the
    21  guidelines for coverage as referenced in this paragraph.
    22    [(C)]  (B)  Coverage  may  be  subject to co-payments, coinsurance and
    23  deductibles as may be deemed appropriate by the  superintendent  and  as
    24  are  consistent with those established for other benefits within a given
    25  policy.
    26    [(D) Coverage shall be limited to  those  individuals  who  have  been
    27  previously covered under the policy for a period of not less than twelve
    28  months,  provided that for the purposes of this paragraph "period of not
    29  less than twelve months" shall be determined by  calculating  such  time
    30  from  either  the  date the insured was first covered under the existing
    31  policy or from the date the insured was first covered  by  a  previously
    32  in-force converted policy, whichever is earlier.
    33    (E)]  (C)  Coverage shall not be required to include the diagnosis and
    34  treatment of infertility in connection with: (i)  [in  vitro  fertiliza-
    35  tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
    36  transfers;  (ii)]  the reversal of elective sterilizations; [(iii)] (ii)
    37  sex change procedures; [(iv)] (iii) cloning; or [(v)]  (iv)  medical  or
    38  surgical  services  or  procedures that are deemed to be experimental in
    39  accordance with clinical guidelines referenced in subparagraph [(F)] (D)
    40  of this paragraph.
    41    [(F)] (D) The superintendent, in consultation with the commissioner of
    42  health, shall promulgate regulations which shall  stipulate  the  guide-
    43  lines  and  standards which shall be used in carrying out the provisions
    44  of this paragraph, which shall include:
    45    (i) [The determination of "infertility" in accordance with the  stand-
    46  ards  and  guidelines established and adopted by the American College of
    47  Obstetricians and Gynecologists and the American Society  for  Reproduc-
    48  tive Medicine;
    49    (ii)] The identification of experimental procedures and treatments not
    50  covered  for  the  diagnosis  and treatment of infertility determined in
    51  accordance with the standards and guidelines established and adopted  by
    52  the American College of Obstetricians and Gynecologists and the American
    53  Society for Reproductive Medicine;
    54    [(iii)]  (ii)  The identification of the required training, experience
    55  and other standards for health  care  providers  for  the  provision  of
    56  procedures and treatments for the diagnosis and treatment of infertility

        S. 719                              5
     1  determined  in  accordance with the standards and guidelines established
     2  and adopted by the American College of Obstetricians  and  Gynecologists
     3  and the American Society for Reproductive Medicine; and
     4    [(iv)]  (iii)  The  determination of appropriate medical candidates by
     5  the treating physician in accordance with the standards  and  guidelines
     6  established  and  adopted  by  the American College of Obstetricians and
     7  Gynecologists and/or the American Society for Reproductive Medicine.
     8    § 6. This act shall take effect on  the  first  day  of  January  next
     9  succeeding  the date on which it shall have become a law and shall apply
    10  to all policies issued, renewed, altered or modified on  or  after  such
    11  date.
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