Chapter 132
2017 -- S 0821 SUBSTITUTE A
Enacted 07/05/2017

A N   A C T
RELATING TO INSURANCE -- COVERAGE FOR INFERTILITY

Introduced By: Senator Maryellen Goodwin
Date Introduced: April 26, 2017

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 that 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 ยง 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 that 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.
     (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 that 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.; Pprovided, 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
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 that 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.
     (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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LC002591/SUB A
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