2017 -- S 0821 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 -- COVERAGE FOR INFERTILITY

     Introduced By: Senator Maryellen Goodwin

     Date Introduced: April 26, 2017

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

the treatment of infertility.

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

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

pregnancy during a period of one year.

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

procedures consistent with established medical practices and professional guidelines published by

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

other reputable professional medical organizations.

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

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

organs or processes.

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

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

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

organizations.

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

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

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

thousand dollars ($100,000).

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

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

     27-19-23. Coverage for infertility.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

period of one year.

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

procedures consistent with established medical practices and professional guidelines published by

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

other reputable professional medical organizations.

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

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

organs or processes.

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

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

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

organizations.

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

thousand dollars ($100,000).

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

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

     27-20-20. Coverage for infertility.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

period of one year.

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

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

other reputable professional medical organizations.

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

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

organs or processes.

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

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

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

organizations.

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

thousand dollars ($100,000).

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

Maintenance Organizations" is hereby amended to read as follows:

     27-41-33. Coverage for infertility.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

period of one year.

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

procedures consistent with established medical practices and professional guidelines published by

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

other reputable professional medical organizations.

LC002591/SUB A - Page 4 of 5

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

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

organs or processes.

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

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

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

organizations.

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

thousand dollars ($100,000).

     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 -- COVERAGE FOR INFERTILITY

***

     This act would mandate insurance coverage for medically necessary expenses for

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

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

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

processes.

     This act would take effect upon passage.

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