Bill Text: NY S06118 | 2023-2024 | General Assembly | Amended

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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 2-0)

Status: (Introduced) 2024-06-07 - COMMITTED TO RULES [S06118 Detail]

Download: New_York-2023-S06118-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         6118--A

                               2023-2024 Regular Sessions

                    IN SENATE

                                     March 30, 2023
                                       ___________

        Introduced  by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and
          when printed to be committed to the Committee on Insurance  --  recom-
          mitted to the Committee on Insurance in accordance with Senate Rule 6,
          sec.  8  --  committee  discharged, bill amended, ordered reprinted as
          amended and recommitted to said committee

        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.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10106-04-3
        S. 6118--A                          2

     1    (II) For purposes of this paragraph, "iatrogenic infertility" means an
     2  impairment of fertility by surgery,  radiation,  chemotherapy  or  other
     3  medical treatment affecting reproductive organs or processes.
     4    (vii)  Every  large  group  policy delivered or issued for delivery in
     5  this state that provides medical, major medical  or  similar  comprehen-
     6  sive-type   coverage  shall  provide  coverage  for  three  [cycles  of]
     7  completed oocyte retrievals and  in-vitro  fertilization  [used  in  the
     8  treatment  of infertility] with unlimited embryo transfers from fresh or
     9  frozen oocytes or embryos from a covered retrieval, in  accordance  with
    10  the  guidelines of the American Society for Reproductive Medicine, using
    11  single embryo transfer (SET) when recommended and medically  appropriate
    12  for the treatment of infertility. Coverage (I) shall not be denied based
    13  on  a  covered individual's participation in fertility services provided
    14  by or to a third party, and (II) may be subject  to  annual  deductibles
    15  and  coinsurance,  including copayments, as may be deemed appropriate by
    16  the superintendent and as are  consistent  with  those  established  for
    17  other  benefits  within  a  given  policy. [For purposes of this item, a
    18  "cycle" is defined as either all treatment that starts when: preparatory
    19  medications  are  administered  for  ovarian  stimulation   for   oocyte
    20  retrieval  with  the intent of undergoing in-vitro fertilization using a
    21  fresh embryo transfer; or medications are administered  for  endometrial
    22  preparation with the intent of undergoing in-vitro fertilization using a
    23  frozen embryo transfer.]
    24    §  3.  Subparagraphs  (E)  and (G) of paragraph 3 of subsection (s) of
    25  section 4303 of the insurance law, as amended by section 2 of part L  of
    26  chapter 57 of the laws of 2019, are amended to read as follows:
    27    (E)(i)  For  the  purposes  of  this subsection, "infertility" means a
    28  disease or condition  characterized  by  the  incapacity  to  impregnate
    29  another person or to conceive, defined by (a) the failure to establish a
    30  clinical  pregnancy  after  twelve months of regular, unprotected sexual
    31  intercourse or therapeutic donor insemination, or after  six  months  of
    32  regular,  unprotected  sexual intercourse or therapeutic donor insemina-
    33  tion for a female thirty-five years of age  or  older;  (b)  a  person's
    34  inability to reproduce either as a single individual or with their part-
    35  ner  without  medical  intervention;  or  (c)  a licensed physician's or
    36  osteopathic physician's findings based on a patient's  medical,  sexual,
    37  or  reproductive history, age, physical findings, or diagnostic testing.
    38  Earlier evaluation and treatment may be warranted based on  an  individ-
    39  ual's medical history or physical findings.
    40    (ii)  For  purposes of this subsection, "iatrogenic infertility" means
    41  an impairment of fertility by surgery, radiation, chemotherapy or  other
    42  medical treatment affecting reproductive organs or processes.
    43    (G) Every large group contract that provides medical, major medical or
    44  similar  comprehensive-type  coverage  shall  provide coverage for three
    45  [cycles of] completed oocyte retrievals and in-vitro fertilization [used
    46  in the treatment of infertility] with unlimited  embryo  transfers  from
    47  fresh  or frozen oocytes or embryos from a covered retrieval, in accord-
    48  ance with the guidelines of the American Society for Reproductive  Medi-
    49  cine,  using single embryo transfer (SET) when recommended and medically
    50  appropriate for the treatment of infertility.  Coverage (i) shall not be
    51  denied based  on  a  covered  individual's  participation  in  fertility
    52  services  provided  by  or  to a third party, and (ii) may be subject to
    53  annual deductibles and coinsurance,  including  copayments,  as  may  be
    54  deemed  appropriate  by  the  superintendent  and as are consistent with
    55  those established for other  benefits  within  a  given  contract.  [For
    56  purposes of this subparagraph, a "cycle" is defined as either all treat-
        S. 6118--A                          3

     1  ment  that  starts  when:  preparatory  medications are administered for
     2  ovarian stimulation for oocyte retrieval with the intent  of  undergoing
     3  in-vitro fertilization using a fresh embryo transfer; or medications are
     4  administered  for  endometrial preparation with the intent of undergoing
     5  in-vitro fertilization using a frozen embryo transfer.]
     6    § 4. This act shall take effect immediately.