2017 -- H 6170 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO INSURANCE

     

     Introduced By: Representatives Serpa, Bennett, McNamara, Solomon, and Shekarchi

     Date Introduced: April 28, 2017

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident

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and Sickness Insurance Policies" is hereby amended to read as follows:

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     27-18-30. Health insurance contracts -- Infertility.

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     (a) Any health insurance contract, plan, or policy delivered or issued for delivery or

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renewed in this state, except contracts providing supplemental coverage to Medicare or other

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governmental programs, which includes pregnancy related benefits, shall provide coverage for

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medically necessary expenses of diagnosis and treatment of infertility for women between the

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ages of twenty-five (25) and forty-two (42) years and for standard fertility preservation services

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when a medically necessary medical treatment may directly or indirectly cause iatrogenic

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infertility to a covered person. To the extent that a health insurance contract provides

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reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than

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infertility, the tests and procedures shall not be excluded from reimbursement when provided

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attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five

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(25) and forty-two (42) years; provided, that a subscriber co-payment not to exceed twenty

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percent (20%) may be required for those programs and/or procedures the sole purpose of which is

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the treatment of infertility.

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     (b) For the purpose purposes of this section, "infertility" means the condition of an

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otherwise presumably healthy married individual who is unable to conceive or sustain a

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pregnancy during a period of one year.

 

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     (c) For the purposes of this section, "standard fertility preservation services" means

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procedures consistent with established medical practices and professional guidelines published by

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the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

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other reputable professional medical organizations.

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     (d) For the purposes of this section, "iatrogenic infertility" means an impairment of

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fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive

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organs or processes.

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     (e) For the purposes of this section, "may directly or indirectly cause" means treatment

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with a likely side effect of infertility as established by the American Society for Reproductive

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Medicine, the American Society of Clinical Oncology, or other reputable professional

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organizations.

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     (c)(f) Notwithstanding the provisions of ยง 27-18-19 or any other provision to the

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contrary, this section shall apply to blanket or group policies of insurance.

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     (d)(g) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit

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Hospital Service Corporations" is hereby amended to read as follows:

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     27-19-23. Coverage for infertility.

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     (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued

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for delivery, or renewed in this state, except contracts providing supplemental coverage to

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Medicare or other governmental programs, which includes pregnancy related benefits shall

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provide coverage for medically necessary expenses of diagnosis and treatment of infertility for

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women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility

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preservation services when a medically necessary medical treatment may directly or indirectly

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cause iatrogenic infertility to a covered person. To the extent that a nonprofit hospital service

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corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of

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conditions other than infertility, those tests and procedures shall not be excluded from

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reimbursement when provided attendant to the diagnosis and treatment of infertility for women

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between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber

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copayment, not to exceed twenty percent (20%), may be required for those programs and/or

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procedures the sole purpose of which is the treatment of infertility.

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     (b) For the purposes of this section, "infertility" means the condition of an otherwise

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presumably healthy married individual who is unable to conceive or sustain a pregnancy during a

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period of one year.

 

LC002543/SUB A - Page 2 of 6

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     (c) For the purposes of this section, "standard fertility preservation services" means

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procedures consistent with established medical practices and professional guidelines published by

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the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

4

other reputable professional medical organizations.

5

     (d) For the purposes of this section, "iatrogenic infertility" means an impairment of

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fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive

7

organs or processes.

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     (e) For the purposes of this section, "may directly or indirectly cause" means treatment

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with a likely side effect of infertility as established by the American Society for Reproductive

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Medicine, the American Society of Clinical Oncology, or other reputable professional

11

organizations.

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     (c)(f) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit

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Medical Service Corporations" is hereby amended to read as follows:

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     27-20-20. Coverage for infertility.

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     (a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued

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for delivery, or renewed in this state, except contracts providing supplemental coverage to

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Medicare or other governmental programs, which includes pregnancy related benefits shall

20

provide coverage for the medically necessary expenses of diagnosis and treatment of infertility

21

for women between the ages of twenty-five (25) and forty-two (42) years and for standard

22

fertility preservation services when a medically necessary medical treatment may directly or

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indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit medical

24

service corporation provides reimbursement for a test or procedure used in the diagnosis or

25

treatment of conditions other than infertility, those tests and procedures shall not be excluded

26

from reimbursement when provided attendant to the diagnosis and treatment of infertility for

27

women between the ages of twenty-five (25) and forty-two (42) years. Provided, that subscriber

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copayment, not to exceed twenty percent (20%), may be required for those programs and/or

29

procedures the sole purpose of which is the treatment of infertility.

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     (b) For the purposes of this section, "infertility" means the condition of an otherwise

31

presumably healthy married individual who is unable to conceive or sustain a pregnancy during a

32

period of one year.

33

     (c) For the purposes of this section, "standard fertility preservation services" means

34

procedures consistent with established medical practices and professional guidelines published by

 

LC002543/SUB A - Page 3 of 6

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the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

2

other reputable professional medical organizations.

3

     (d) For the purposes of this section, "iatrogenic infertility" means an impairment of

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fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive

5

organs or processes.

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     (e) For the purposes of this section, "may directly or indirectly cause" means treatment

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with a likely side effect of infertility as established by the American Society for Reproductive

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Medicine, the American Society of Clinical Oncology, or other reputable professional

9

organizations.

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     (c)(f) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health

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Maintenance Organizations" is hereby amended to read as follows:

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     27-41-33. Coverage for infertility.

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     (a) Any health maintenance organization service contract plan or policy delivered, issued

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for delivery, or renewed in this state, except a contract providing supplemental coverage to

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Medicare or other governmental programs, which includes pregnancy related benefits, shall

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provide coverage for medically necessary expenses of diagnosis and treatment of diagnosis and

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treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years

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and for standard fertility preservation services when a medically necessary medical treatment may

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directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health

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maintenance organization provides reimbursement for a test or procedure used in the diagnosis or

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treatment of conditions other than infertility, those tests and procedures shall not be excluded

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from reimbursement when provided attendant to the diagnosis and treatment of infertility for

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women between the ages of twenty-five (25) and forty-two (42) years; provided, that subscriber

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copayment, not to exceed twenty percent (20%), may be required for those programs and/or

27

procedures the sole purpose of which is the treatment of infertility.

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     (b) For the purpose purposes of this section, "infertility" means the condition of an

29

otherwise healthy married individual who is unable to conceive or sustain a pregnancy during a

30

period of one year.

31

     (c) For the purposes of this section, "standard fertility preservation services" means

32

procedures consistent with established medical practices and professional guidelines published by

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the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or

34

other reputable professional medical organizations.

 

LC002543/SUB A - Page 4 of 6

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     (d) For the purposes of this section, "iatrogenic infertility" means an impairment of

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fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive

3

organs or processes.

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     (e) For the purposes of this section, "may directly or indirectly cause" means treatment

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with a likely side effect of infertility as established by the American Society for Reproductive

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Medicine, the American Society of Clinical Oncology, or other reputable professional

7

organizations.

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     (c)(f) The health insurance contract may limit coverage to a lifetime cap of one hundred

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thousand dollars ($100,000).

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE

***

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     This act would mandate insurance coverage for medically necessary expenses for

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standard fertility preservation services when a medical treatment may directly or indirectly cause

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iatrogenic infertility. "Iatrogenic infertility" means an impairment of fertility as a result of

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surgery, radiation, chemotherapy or other medical treatment affecting the reproductive organs or

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processes.

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     This act would take effect upon passage.

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