Bill Text: NY S08441 | 2017-2018 | General Assembly | Amended
Bill Title: Relates to insurance coverage up to fifty thousand dollars for women ages 21 to 44 for in vitro fertilization and other fertility preservation treatments.
Spectrum: Partisan Bill (Republican 10-0)
Status: (Engrossed - Dead) 2018-06-20 - referred to insurance [S08441 Detail]
Download: New_York-2017-S08441-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 8441--B IN SENATE May 7, 2018 ___________ Introduced by Sens. PHILLIPS, HELMING, AKSHAR, BONACIC, LITTLE, MARCHIONE, O'MARA, YOUNG -- 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 -- 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; and to amend part K of chapter 82 of the laws of 2002 amending the insurance law and the public health law relating to coverage for the diagnosis and treatment of infertility, in relation to grants for infertility services 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 a 6 maximum lifetime limit of fifty thousand dollars 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) For the purposes of subparagraph (C) of this paragraph: 12 (i) "Infertility" means a condition or disease characterized by the 13 incapacity to impregnate another person or to conceive, as diagnosed or 14 determined (I) by a physician licensed to practice medicine in this 15 state, or (II) by the failure to establish a clinical pregnancy after 16 twelve months of regular, unprotected sexual intercourse, or after six 17 months of regular, unprotected sexual intercourse in the case of a 18 female over age thirty-five. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD04562-13-8S. 8441--B 2 1 (ii) "Iatrogenic infertility" means an impairment of fertility by 2 surgery, radiation, chemotherapy or other medical treatment affecting 3 reproductive organs or processes. 4 (iii) Coverage for prescription drugs necessary as part of in vitro 5 fertilization or standard fertility preservation services is only avail- 6 able where the policy otherwise provides coverage for prescription 7 drugs. 8 (iv) Notwithstanding any other provision of law, a policy may impose 9 cost sharing, deductibles or coinsurance obligations that exceed the 10 dollar amount of cost sharing, deductibles or coinsurance obligations 11 for non-preferred brand name drugs or their equivalent. 12 (E) For services provided pursuant to subparagraph (C) of this para- 13 graph, policies may: 14 (i) Require that services be performed by clinics or medical centers 15 that conform to guidelines issued by the American Society for Reproduc- 16 tive Medicine or the American College of Obstetricians and Gynecologists 17 (ACOG); 18 (ii) Require, notwithstanding network adequacy requirements, that all 19 services be performed at designated providers identified by the insurer 20 as meeting specified credentialing and quality standards and which 21 participate in the insurer's provider network; 22 (iii) Limit coverage for in vitro fertilization to those individuals 23 who have been unable to conceive or produce conception through less 24 expensive and medically viable infertility treatment or procedures 25 covered under such policy. Nothing in this subsection shall be construed 26 to deny the coverage required by this section to any individual who 27 foregoes a particular infertility treatment or procedure if the individ- 28 ual's physician determines that such treatment or procedure is likely to 29 be unsuccessful; 30 (iv) For purposes of calculating the lifetime limit, require disclo- 31 sure by the individual seeking such coverage to such individual's exist- 32 ing health insurance carrier of any previous infertility treatment or 33 procedures for which such individual received coverage under a different 34 health insurance policy issued by the same insurer or by another insur- 35 er; or 36 (v) Limit coverage related to in vitro fertilization services to 37 persons whose ages range from twenty-one through forty-four years. 38 § 2. Paragraph 6 of subsection (k) of section 3221 of the insurance 39 law is amended by adding four new subparagraphs (E), (F), (G) and (H) to 40 read as follows: 41 (E) Every group policy delivered or issued for delivery in this state 42 that provides hospital, surgical or medical coverage shall provide a 43 maximum lifetime limit of fifty thousand dollars of coverage for: 44 (i) in vitro fertilization used in the treatment of infertility; and 45 (ii) standard fertility preservation services when a necessary medical 46 treatment may directly or indirectly cause iatrogenic infertility to a 47 covered person. 48 (F) For the purposes of subparagraph (E) of this paragraph: 49 (i) "Infertility" means a condition or disease characterized by the 50 incapacity to impregnate another person or to conceive, as diagnosed or 51 determined (I) by a physician licensed to practice medicine in this 52 state, or (II) by the failure to establish a clinical pregnancy after 53 twelve months of regular, unprotected sexual intercourse, or after six 54 months of regular, unprotected sexual intercourse in the case of a 55 female over age thirty-five.S. 8441--B 3 1 (ii) "Iatrogenic infertility" means an impairment of fertility by 2 surgery, radiation, chemotherapy or other medical treatment affecting 3 reproductive organs or processes. 4 (iii) Coverage for prescription drugs necessary as part of in vitro 5 fertilization or standard fertility preservation services is only avail- 6 able where the policy otherwise provides coverage for prescription 7 drugs. 8 (iv) Notwithstanding any other provision of law, a policy may impose 9 cost sharing, deductibles or coinsurance obligations that exceed the 10 dollar amount of cost sharing, deductibles or coinsurance obligations 11 for non-preferred brand name drugs or their equivalent. 12 (G) Notwithstanding any other provision of this subsection, a reli- 13 gious employer may request a contract without coverage for in vitro 14 fertilization used in the treatment of infertility and standard fertili- 15 ty preservation services that are contrary to the religious employer's 16 religious tenets. If so requested, such contract shall be provided with- 17 out coverage for services. 18 (i) For purposes of this subsection, a "religious employer" is a group 19 or entity for which each of the following is true: 20 (I) The inculcation of religious values is the purpose of the group or 21 entity. 22 (II) The group or entity primarily employs persons who share the reli- 23 gious tenets of the group or entity. 24 (III) The group or entity serves primarily persons who share the reli- 25 gious tenets of the group or entity. 26 (IV) The group or entity is a nonprofit organization as described in 27 Section 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as 28 amended. 29 (ii) Every religious employer that invokes the exemption provided 30 under this subparagraph shall provide written notice to prospective 31 enrollees prior to enrollment with the plan, listing the treatment of 32 infertility and standard fertility preservation services the employer 33 refuses to cover for religious reasons. 34 (H) For services provided pursuant to subparagraph (E) of this para- 35 graph, policies may: 36 (i) Require that services be performed by clinics or medical centers 37 that conform to guidelines issued by the American Society for Reproduc- 38 tive Medicine or the American College of Obstetricians and Gynecologists 39 (ACOG); 40 (ii) Require, notwithstanding network adequacy requirements, that all 41 services be performed at designated providers identified by the insurer 42 as meeting specified credentialing and quality standards and which 43 participate in the insurer's provider network; 44 (iii) Limit coverage for in vitro fertilization to those individuals 45 who have been unable to conceive or produce conception through less 46 expensive and medically viable infertility treatment or procedures 47 covered under such policy. Nothing in this subsection shall be construed 48 to deny the coverage required by this section to any individual who 49 foregoes a particular infertility treatment or procedure if the individ- 50 ual's physician determines that such treatment or procedure is likely to 51 be unsuccessful; 52 (iv) For purposes of calculating the lifetime limit, require disclo- 53 sure by the individual seeking such coverage to such individual's exist- 54 ing health insurance carrier of any previous infertility treatment or 55 procedures for which such individual received coverage under a differentS. 8441--B 4 1 health insurance policy issued by the same insurer or by another insur- 2 er; or 3 (v) Limit coverage related to in vitro fertilization services to 4 persons whose ages range from twenty-one through forty-four years. 5 § 3. Subsection (s) of section 4303 of the insurance law, as amended 6 by section 2 of part F of chapter 82 of the laws of 2002, is amended by 7 adding four new paragraphs 5, 6, 7 and 8 to read as follows: 8 (5) Every contract issued by a medical expense indemnity corporation, 9 hospital service corporation or health service corporation for delivery 10 in this state that provides hospital, surgical or medical coverage shall 11 provide a maximum lifetime limit of fifty thousand dollars of coverage 12 for: 13 (A) in vitro fertilization used in the treatment of infertility; and 14 (B) standard fertility preservation services when a necessary medical 15 treatment may directly or indirectly cause iatrogenic infertility to a 16 covered person. 17 (6) For the purposes of paragraph five of this subsection: 18 (A) "Infertility" means a condition or disease characterized by the 19 incapacity to impregnate another person or to conceive, as diagnosed or 20 determined (i) by a physician licensed to practice medicine in this 21 state, or (ii) by the failure to establish a clinical pregnancy after 22 twelve months of regular, unprotected sexual intercourse, or after six 23 months of regular, unprotected sexual intercourse in the case of a 24 female over age thirty-five. 25 (B) "Iatrogenic infertility" means an impairment of fertility by 26 surgery, radiation, chemotherapy or other medical treatment affecting 27 reproductive organs or processes. 28 (C) Coverage for prescription drugs necessary as part of in vitro 29 fertilization or standard fertility preservation services is only avail- 30 able where the policy otherwise provides coverage for prescription 31 drugs. 32 (D) Notwithstanding any other provision of law, a policy may impose 33 cost sharing, deductibles or coinsurance obligations that exceed the 34 dollar amount of cost sharing, deductibles or coinsurance obligations 35 for non-preferred brand name drugs or their equivalent. 36 (7) Notwithstanding any other provision of this subsection, a reli- 37 gious employer may request a contract without coverage for in vitro 38 fertilization used in the treatment of infertility and standard fertili- 39 ty preservation services that are contrary to the religious employer's 40 religious tenets. If so requested, such contract shall be provided with- 41 out coverage for services. 42 (A) For purposes of this subsection, a "religious employer" is a group 43 or entity for which each of the following is true: 44 (i) The inculcation of religious values is the purpose of the group or 45 entity. 46 (ii) The group or entity primarily employs persons who share the reli- 47 gious tenets of the group or entity. 48 (iii) The group or entity serves primarily persons who share the reli- 49 gious tenets of the group or entity. 50 (iv) The group or entity is a nonprofit organization as described in 51 Section 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as 52 amended. 53 (B) Every religious employer that invokes the exemption provided under 54 this paragraph shall provide written notice to prospective enrollees 55 prior to enrollment with the plan, listing the treatment of infertilityS. 8441--B 5 1 and standard fertility preservation services the employer refuses to 2 cover for religious reasons. 3 (8) For services provided pursuant to paragraph five of this 4 subsection, policies may: 5 (A) Require that services be performed by clinics or medical centers 6 that conform to guidelines issued by the American Society for Reproduc- 7 tive Medicine or the American College of Obstetricians and Gynecologists 8 (ACOG); 9 (B) Require, notwithstanding network adequacy requirements, that all 10 services be performed at designated providers identified by the insurer 11 as meeting specified credentialing and quality standards and which 12 participate in the insurer's provider network; 13 (C) Limit coverage for in vitro fertilization to those individuals who 14 have been unable to conceive or produce conception through less expen- 15 sive and medically viable infertility treatment or procedures covered 16 under such policy. Nothing in this subsection shall be construed to deny 17 the coverage required by this section to any individual who foregoes a 18 particular infertility treatment or procedure if the individual's physi- 19 cian determines that such treatment or procedure is likely to be unsuc- 20 cessful; 21 (D) For purposes of calculating the lifetime limit, require disclosure 22 by the individual seeking such coverage to such individual's existing 23 health insurance carrier of any previous infertility treatment or proce- 24 dures for which such individual received coverage under a different 25 health insurance policy issued by the same insurer or by another insur- 26 er; or 27 (E) Limit coverage related to in vitro fertilization services to 28 persons whose ages range from twenty-one through forty-four years. 29 § 4. Subparagraph (C) of paragraph 6 of subsection (k) of section 3221 30 of the insurance law, as amended by section 1 of part K of chapter 82 of 31 the laws of 2002, is amended to read as follows: 32 (C) Coverage of diagnostic and treatment procedures, including 33 prescription drugs, used in the diagnosis and treatment of infertility 34 as required by subparagraphs (A) and (B) of this paragraph shall be 35 provided in accordance with the provisions of this subparagraph. 36 (i) Coverage shall be provided for persons whose ages range from twen- 37 ty-one through forty-four years, provided that nothing herein shall 38 preclude the provision of coverage to persons whose age is below or 39 above such range. 40 (ii) Diagnosis and treatment of infertility shall be prescribed as 41 part of a physician's overall plan of care and consistent with the 42 guidelines for coverage as referenced in this subparagraph. 43 (iii) Coverage may be subject to co-payments, coinsurance and deduct- 44 ibles as may be deemed appropriate by the superintendent and as are 45 consistent with those established for other benefits within a given 46 policy. 47 (iv) [Coverage shall be limited to those individuals who have been48previously covered under the policy for a period of not less than twelve49months, provided that for the purposes of this subparagraph "period of50not less than twelve months" shall be determined by calculating such51time from either the date the insured was first covered under the exist-52ing policy or from the date the insured was first covered by a previous-53ly in-force converted policy, whichever is earlier.54(v)] Coverage shall not be required to include the diagnosis and 55 treatment of infertility in connection with: (I) [in vitro fertiliza-56tion,] gamete intrafallopian tube transfers or zygote intrafallopianS. 8441--B 6 1 tube transfers; (II) the reversal of elective sterilizations; (III) sex 2 change procedures; (IV) cloning; or (V) medical or surgical services or 3 procedures that are deemed to be experimental in accordance with clin- 4 ical guidelines referenced in clause [(vi)] (v) of this subparagraph. 5 [(vi)] (v) The superintendent, in consultation with the commissioner 6 of health, shall promulgate regulations which shall stipulate the guide- 7 lines and standards which shall be used in carrying out the provisions 8 of this subparagraph, which shall include: 9 (I) The determination of "infertility" in accordance with the stand- 10 ards and guidelines established and adopted by the American College of 11 Obstetricians and Gynecologists and the American Society for Reproduc- 12 tive Medicine; 13 (II) The identification of experimental procedures and treatments not 14 covered for the diagnosis and treatment of infertility determined in 15 accordance with the standards and guidelines established and adopted by 16 the American College of Obstetricians and Gynecologists and the American 17 Society for Reproductive Medicine; 18 (III) The identification of the required training, experience and 19 other standards for health care providers for the provision of proce- 20 dures and treatments for the diagnosis and treatment of infertility 21 determined in accordance with the standards and guidelines established 22 and adopted by the American College of Obstetricians and Gynecologists 23 and the American Society for Reproductive Medicine; and 24 (IV) The determination of appropriate medical candidates by the treat- 25 ing physician in accordance with the standards and guidelines estab- 26 lished and adopted by the American College of Obstetricians and Gynecol- 27 ogists and/or the American Society for Reproductive Medicine. 28 § 5. Paragraph 3 of subsection (s) of section 4303 of the insurance 29 law, as amended by section 2 of part K of chapter 82 of the laws of 30 2002, is amended to read as follows: 31 (3) Coverage of diagnostic and treatment procedures, including 32 prescription drugs used in the diagnosis and treatment of infertility as 33 required by paragraphs one and two of this subsection shall be provided 34 in accordance with this paragraph. 35 (A) Coverage shall be provided for persons whose ages range from twen- 36 ty-one through forty-four years, provided that nothing herein shall 37 preclude the provision of coverage to persons whose age is below or 38 above such range. 39 (B) Diagnosis and treatment of infertility shall be prescribed as part 40 of a physician's overall plan of care and consistent with the guidelines 41 for coverage as referenced in this paragraph. 42 (C) Coverage may be subject to co-payments, coinsurance and deduct- 43 ibles as may be deemed appropriate by the superintendent and as are 44 consistent with those established for other benefits within a given 45 policy. 46 [(D) Coverage shall be limited to those individuals who have been47previously covered under the policy for a period of not less than twelve48months, provided that for the purposes of this paragraph "period of not49less than twelve months" shall be determined by calculating such time50from either the date the insured was first covered under the existing51policy or from the date the insured was first covered by a previously52in-force converted policy, whichever is earlier.53(E)] (D) Coverage shall not be required to include the diagnosis and 54 treatment of infertility in connection with: (i) [in vitro fertiliza-55tion,] gamete intrafallopian tube transfers or zygote intrafallopian 56 tube transfers; (ii) the reversal of elective sterilizations; (iii) sexS. 8441--B 7 1 change procedures; (iv) cloning; or (v) medical or surgical services or 2 procedures that are deemed to be experimental in accordance with clin- 3 ical guidelines referenced in subparagraph [(F)] (E) of this paragraph. 4 [(F)] (E) The superintendent, in consultation with the commissioner of 5 health, shall promulgate regulations which shall stipulate the guide- 6 lines and standards which shall be used in carrying out the provisions 7 of this paragraph, which shall include: 8 (i) The determination of "infertility" in accordance with the stand- 9 ards and guidelines established and adopted by the American College of 10 Obstetricians and Gynecologists and the American Society for Reproduc- 11 tive Medicine; 12 (ii) The identification of experimental procedures and treatments not 13 covered for the diagnosis and treatment of infertility determined in 14 accordance with the standards and guidelines established and adopted by 15 the American College of Obstetricians and Gynecologists and the American 16 Society for Reproductive Medicine; 17 (iii) The identification of the required training, experience and 18 other standards for health care providers for the provision of proce- 19 dures and treatments for the diagnosis and treatment of infertility 20 determined in accordance with the standards and guidelines established 21 and adopted by the American College of Obstetricians and Gynecologists 22 and the American Society for Reproductive Medicine; and 23 (iv) The determination of appropriate medical candidates by the treat- 24 ing physician in accordance with the standards and guidelines estab- 25 lished and adopted by the American College of Obstetricians and Gynecol- 26 ogists and/or the American Society for Reproductive Medicine. 27 § 6. Section 4 of part K of chapter 82 of the laws of 2002, amending 28 the insurance law and the public health law relating to coverage for the 29 diagnosis and treatment of infertility, is amended to read as follows: 30 § 4. The commissioner of health, subject to the availability of funds 31 pursuant to section 2807-v of the public health law, shall establish a 32 program to provide grants to health care providers for the purpose of 33 improving access to infertility services, treatments and procedures. At 34 least one such provider shall be located in the city of New York and one 35 such provider shall be located in an upstate region. 36 Such program shall be targeted to assist individuals in meeting the 37 cost of infertility services not covered pursuant to sections 3221 and 38 4303 of the insurance law as such sections are amended by sections one 39 and two of this act relating to expanded coverage of infertility 40 services. Services, treatments and procedures paid for pursuant to the 41 grant program shall be limited to: (a) those who meet the criteria for 42 such expanded coverage provided pursuant to the insurance law but for 43 whom the covered services are not effective for treating infertility, 44 and those who are unable to access coverage for the expanded procedures 45 enacted pursuant to a chapter of the laws of 2018; and (b) those who are 46 not enrolled in a commercial health care plan but who would otherwise 47 meet the criteria of subdivision (a) of this section. Services, treat- 48 ments and procedures paid for pursuant to the grant program shall be 49 further limited to assisted reproductive technology utilizing in vitro 50 fertilization and gamete intrafallopian tube transfer, and shall be made 51 available only in accordance with standards, protocols and other parame- 52 ters as shall be established by the commissioner, which shall include 53 but not be limited to ASRM and ACOG standards for the appropriateness of 54 individuals, providers and treatments, and standards relating to cost- 55 sharing based on income. Services, treatments and procedures under the 56 grant program, except for those specified herein, shall not includeS. 8441--B 8 1 those services, treatments and procedures explicitly excluded under the 2 expanded coverage provided for in the insurance law as amended by 3 sections one and two of this act. Notwithstanding sections 112 and 163 4 of the state finance law, grants provided pursuant to such program may 5 be made without competitive bid or request for proposal. 6 The commissioner of health shall promote public awareness of this 7 program. 8 § 7. The superintendent of financial services in consultation with 9 the commissioner of health, shall reassess the coverage requirements of 10 this act and regulations promulgated thereunder pursuant to a review of 11 the comprehensive report funded pursuant to appropriation by chapter 50 12 of the laws of 2018 and the request for quote number C000457. 13 § 8. This act shall take effect January 1, 2020 and shall apply to all 14 policies issued, renewed, altered or modified on or after such date; 15 provided, however, that should this act be determined to be a mandate 16 pursuant to section 1311 (d)(3)(B) of the Patient Protection and Afford- 17 able Care Act, then this act shall not apply to coverage offered in the 18 individual and small group market unless the state appropriates funds 19 sufficient to cover the full cost of such coverage, as determined by the 20 department of financial services and independently verified by an inde- 21 pendent actuarial firm certified by the American academy of actuaries. 22 In addition, the superintendent of financial services shall permit 23 insurers and other organizations subject to this act to establish a 24 minimum factor attributable to the services covered pursuant to this 25 chapter that may be incorporated into rates for large group policies 26 issued on or after January 1, 2020. Provided further, however, that 27 should this act be determined not to be a mandate pursuant to section 28 1311(d)(3)(B) of the Patient Protection and Affordable Care Act, then 29 the superintendent of financial services shall include in the approved 30 small group and individual rates a factor attributable to the cost of 31 services covered pursuant to this chapter and consistent with the actu- 32 arial cost, as projected by the applicant, of such coverage that shall 33 be incorporated into rates for policies issued on or after January 1, 34 2020.