Bill Text: NY S03148 | 2017-2018 | General Assembly | Amended
Bill Title: Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.
Spectrum: Slight Partisan Bill (Democrat 18-9)
Status: (Introduced - Dead) 2018-01-03 - REFERRED TO INSURANCE [S03148 Detail]
Download: New_York-2017-S03148-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 3148--A 2017-2018 Regular Sessions IN SENATE January 20, 2017 ___________ Introduced by Sens. SAVINO, ALCANTARA, AVELLA, BAILEY, CARLUCCI, CROCI, HAMILTON, HOYLMAN, KAMINSKY, LATIMER, PERALTA, ROBACH, VALESKY -- read twice and ordered printed, and when printed to be committed 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- 21 ation, chemotherapy or other medical treatment affecting reproductive 22 organs or processes. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04562-04-7S. 3148--A 2 1 (E) No insurer providing coverage under this paragraph shall discrimi- 2 nate based on a covered individual's expected length of life, present or 3 predicted disability, degree of medical dependency, perceived quality of 4 life, or other health conditions, nor based on personal characteristics, 5 including age, sex, sexual orientation, marital status or gender identi- 6 ty. 7 § 2. Paragraph 6 of subsection (k) of section 3221 of the insurance 8 law is amended by adding three new subparagraphs (E), (F) and (G) to 9 read as follows: 10 (E) Every group policy delivered or issued for delivery in this state 11 that provides hospital, surgical or medical coverage shall provide 12 coverage for: 13 (i) in vitro fertilization used in the treatment of infertility; and 14 (ii) standard fertility preservation services when a necessary medical 15 treatment may directly or indirectly cause iatrogenic infertility to a 16 covered person. 17 (F) (i) For the purposes of subparagraph (E) of this paragraph, 18 "infertility" means a disease or condition characterized by the incapac- 19 ity to impregnate another person or to conceive, as diagnosed or deter- 20 mined (I) by a physician licensed to practice medicine in this state, or 21 (II) by the failure to establish a clinical pregnancy after twelve 22 months of regular, unprotected sexual intercourse, or after six months 23 of regular, unprotected sexual intercourse in the case of a female thir- 24 ty-five years of age or older. 25 (ii) For the purposes of subparagraph (E) of this paragraph, "iatro- 26 genic infertility" means an impairment of fertility by surgery, radi- 27 ation, chemotherapy or other medical treatment affecting reproductive 28 organs or processes. 29 (G) No insurer providing coverage under this paragraph shall discrimi- 30 nate based on a covered individual's expected length of life, present or 31 predicted disability, degree of medical dependency, perceived quality of 32 life, or other health conditions, nor based on personal characteristics, 33 including age, sex, sexual orientation, marital status or gender identi- 34 ty. 35 § 3. Subsection (s) of section 4303 of the insurance law, as amended 36 by section 2 of part F of chapter 82 of the laws of 2002, is amended by 37 adding three new paragraphs (5), (6) and (7) to read as follows: 38 (5) Every contract issued by a medical expense indemnity corporation, 39 hospital service corporation or health service corporation for delivery 40 in this state that provides hospital, surgical or medical coverage shall 41 provide coverage for: 42 (A) in vitro fertilization used in the treatment of infertility; and 43 (B) standard fertility preservation services when a necessary medical 44 treatment may directly or indirectly cause iatrogenic infertility to a 45 covered person. 46 (6) (A) For the purposes of paragraph five of this subsection, "infer- 47 tility" means a disease or condition characterized by the incapacity to 48 impregnate another person or to conceive, as diagnosed or determined (i) 49 by a physician licensed to practice medicine in this state, or (ii) by 50 the failure to establish a clinical pregnancy after twelve months of 51 regular, unprotected sexual intercourse, or after six months of regular, 52 unprotected sexual intercourse in the case of a female thirty-five years 53 of age or older. 54 (B) For the purposes of paragraph five of this subsection, "iatrogenic 55 infertility" means an impairment of fertility by surgery, radiation,S. 3148--A 3 1 chemotherapy or other medical treatment affecting reproductive organs or 2 processes. 3 (7) No medical expense indemnity corporation, hospital service corpo- 4 ration or health service corporation providing coverage under this 5 subsection shall discriminate based on a covered individual's expected 6 length of life, present or predicted disability, degree of medical 7 dependency, perceived quality of life, or other health conditions, nor 8 based on personal characteristics, including age, sex, sexual orien- 9 tation, marital status or gender identity. 10 § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221 11 of the insurance law, as amended by section 1 of part K of chapter 82 of 12 the laws of 2002, is amended to read as follows: 13 (C) Coverage of diagnostic and treatment procedures, including 14 prescription drugs, used in the diagnosis and treatment of infertility 15 as required by subparagraphs (A) and (B) of this paragraph shall be 16 provided in accordance with the provisions of this subparagraph. 17 (i) [Coverage shall be provided for persons whose ages range from18twenty-one through forty-four years, provided that nothing herein shall19preclude the provision of coverage to persons whose age is below or20above such range.21(ii)] Diagnosis and treatment of infertility shall be prescribed as 22 part of a physician's overall plan of care and consistent with the 23 guidelines for coverage as referenced in this subparagraph. 24 [(iii)] (ii) Coverage may be subject to co-payments, coinsurance and 25 deductibles as may be deemed appropriate by the superintendent and as 26 are consistent with those established for other benefits within a given 27 policy. 28 [(iv) Coverage shall be limited to those individuals who have been29previously covered under the policy for a period of not less than twelve30months, provided that for the purposes of this subparagraph "period of31not less than twelve months" shall be determined by calculating such32time from either the date the insured was first covered under the exist-33ing policy or from the date the insured was first covered by a previous-34ly in-force converted policy, whichever is earlier.35(v)] (iii) Coverage shall not be required to include the diagnosis and 36 treatment of infertility in connection with: (I) [in vitro fertiliza-37tion, gamete intrafallopian tube transfers or zygote intrafallopian tube38transfers; (II)] the reversal of elective sterilizations; [(III)] (II) 39 sex change procedures; [(IV)] (III) cloning; or [(V)] (IV) medical or 40 surgical services or procedures that are deemed to be experimental in 41 accordance with clinical guidelines referenced in clause [(vi)] (iv) of 42 this subparagraph. 43 [(vi)] (iv) The superintendent, in consultation with the commissioner 44 of health, shall promulgate regulations which shall stipulate the guide- 45 lines and standards which shall be used in carrying out the provisions 46 of this subparagraph, which shall include: 47 (I) [The determination of "infertility" in accordance with the stand-48ards and guidelines established and adopted by the American College of49Obstetricians and Gynecologists and the American Society for Reproduc-50tive Medicine;51(II)] The identification of experimental procedures and treatments not 52 covered for the diagnosis and treatment of infertility determined in 53 accordance with the standards and guidelines established and adopted by 54 the American College of Obstetricians and Gynecologists and the American 55 Society for Reproductive Medicine;S. 3148--A 4 1 [(III)] (II) The identification of the required training, experience 2 and other standards for health care providers for the provision of 3 procedures and treatments for the diagnosis and treatment of infertility 4 determined in accordance with the standards and guidelines established 5 and adopted by the American College of Obstetricians and Gynecologists 6 and the American Society for Reproductive Medicine; and 7 [(IV)] (III) The determination of appropriate medical candidates by 8 the treating physician in accordance with the standards and guidelines 9 established and adopted by the American College of Obstetricians and 10 Gynecologists and/or the American Society for Reproductive Medicine. 11 § 5. Paragraph 3 of subsection (s) of section 4303 of the insurance 12 law, as amended by section 2 of part K of chapter 82 of the laws of 13 2002, is amended to read as follows: 14 (3) Coverage of diagnostic and treatment procedures, including 15 prescription drugs used in the diagnosis and treatment of infertility as 16 required by paragraphs one and two of this subsection shall be provided 17 in accordance with this paragraph. 18 (A) [Coverage shall be provided for persons whose ages range from19twenty-one through forty-four years, provided that nothing herein shall20preclude the provision of coverage to persons whose age is below or21above such range.22(B)] Diagnosis and treatment of infertility shall be prescribed as 23 part of a physician's overall plan of care and consistent with the 24 guidelines for coverage as referenced in this paragraph. 25 [(C)] (B) Coverage may be subject to co-payments, coinsurance and 26 deductibles as may be deemed appropriate by the superintendent and as 27 are consistent with those established for other benefits within a given 28 policy. 29 [(D) Coverage shall be limited to those individuals who have been30previously covered under the policy for a period of not less than twelve31months, provided that for the purposes of this paragraph "period of not32less than twelve months" shall be determined by calculating such time33from either the date the insured was first covered under the existing34policy or from the date the insured was first covered by a previously35in-force converted policy, whichever is earlier.36(E)] (C) Coverage shall not be required to include the diagnosis and 37 treatment of infertility in connection with: (i) [in vitro fertiliza-38tion, gamete intrafallopian tube transfers or zygote intrafallopian tube39transfers; (ii)] the reversal of elective sterilizations; [(iii)] (ii) 40 sex change procedures; [(iv)] (iii) cloning; or [(v)] (iv) medical or 41 surgical services or procedures that are deemed to be experimental in 42 accordance with clinical guidelines referenced in subparagraph [(F)] (D) 43 of this paragraph. 44 [(F)] (D) The superintendent, in consultation with the commissioner of 45 health, shall promulgate regulations which shall stipulate the guide- 46 lines and standards which shall be used in carrying out the provisions 47 of this paragraph, which shall include: 48 (i) [The determination of "infertility" in accordance with the stand-49ards and guidelines established and adopted by the American College of50Obstetricians and Gynecologists and the American Society for Reproduc-51tive Medicine;52(ii)] The identification of experimental procedures and treatments not 53 covered for the diagnosis and treatment of infertility determined in 54 accordance with the standards and guidelines established and adopted by 55 the American College of Obstetricians and Gynecologists and the American 56 Society for Reproductive Medicine;S. 3148--A 5 1 [(iii)] (ii) The identification of the required training, experience 2 and other standards for health care providers for the provision of 3 procedures and treatments for the diagnosis and treatment of infertility 4 determined in accordance with the standards and guidelines established 5 and adopted by the American College of Obstetricians and Gynecologists 6 and the American Society for Reproductive Medicine; and 7 [(iv)] (iii) The determination of appropriate medical candidates by 8 the treating physician in accordance with the standards and guidelines 9 established and adopted by the American College of Obstetricians and 10 Gynecologists and/or the American Society for Reproductive Medicine. 11 § 6. This act shall take effect on the first day of January next 12 succeeding the date on which it shall have become a law and shall apply 13 to all policies issued, renewed, altered or modified on or after such 14 date.