S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2415
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 20, 2017
                                ___________
 
 Introduced  by  M.  of  A. PAULIN, STECK, GOTTFRIED, ROSENTHAL, SIMOTAS,
   ZEBROWSKI -- Multi-Sponsored by -- M. of A. COOK, PERRY, TITONE, WALK-
   ER -- read once and referred to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation  to  mandating  insurance
   companies  to provide coverage for non-experimental infertility treat-
   ments
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  13  of  subsection  (i) of section 3216 of the
 insurance law, as added by chapter 897 of the laws of  1990  and  renum-
 bered by chapter 131 of the laws of 1992, is amended to read as follows:
   (13)  (A) Every policy which provides coverage for hospital care shall
 not exclude coverage for hospital care for diagnosis  and  treatment  of
 correctable  medical  conditions  otherwise covered by the policy solely
 because the medical condition results in infertility[.]; PROVIDED HOWEV-
 ER THAT:
   (I) SUBJECT TO THE PROVISIONS OF SUBPARAGRAPH (C) OF  THIS  PARAGRAPH,
 IN  NO  CASE  SHALL SUCH COVERAGE EXCLUDE SURGICAL OR MEDICAL PROCEDURES
 PROVIDED AS PART OF SUCH HOSPITAL CARE WHICH WOULD CORRECT MALFORMATION,
 DISEASE OR DYSFUNCTION RESULTING IN INFERTILITY; AND
   (II) PROVIDED, FURTHER HOWEVER, THAT  SUBJECT  TO  THE  PROVISIONS  OF
 SUBPARAGRAPH  (C)  OF  THIS  PARAGRAPH,  IN  NO CASE SHALL SUCH COVERAGE
 EXCLUDE DIAGNOSTIC TESTS AND PROCEDURES PROVIDED AS PART OF SUCH  HOSPI-
 TAL  CARE THAT ARE NECESSARY TO DETERMINE INFERTILITY OR THAT ARE NECES-
 SARY  IN  CONNECTION  WITH  ANY  SURGICAL  OR  MEDICAL   TREATMENTS   OR
 PRESCRIPTION  DRUG COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH, INCLUD-
 ING SUCH DIAGNOSTIC TESTS AND PROCEDURES AS HYSTEROSALPINGOGRAM, HYSTER-
 OSCOPY, ENDOMETRIAL BIOPSY, LAPAROSCOPY, SONO-HYSTEROGRAM,  POST  COITAL
 TESTS, TESTIS BIOPSY, SEMEN ANALYSIS, BLOOD TESTS, ULTRASOUND, OVULATION
 INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO FERTILIZATION, INTRACYTO-
 PLASMIC  SPERM INJECTION, UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER, GAMETE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD06452-01-7

 A. 2415                             2
 
 INTRA-FALLOPIAN TRANSFER, ZYGOTE  INTRA-FALLOPIAN  TRANSFER,  LOW  TUBAL
 OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM; AND
   (III)  PROVIDED,  FURTHER  HOWEVER,  EVERY  SUCH POLICY WHICH PROVIDES
 COVERAGE FOR PRESCRIPTION DRUGS SHALL  INCLUDE,  WITHIN  SUCH  COVERAGE,
 COVERAGE  FOR  PRESCRIPTION  DRUGS APPROVED BY THE FEDERAL FOOD AND DRUG
 ADMINISTRATION FOR USE IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY  IN
 ACCORDANCE WITH SUBPARAGRAPH (C) OF THIS PARAGRAPH.
   (B) Every policy which provides coverage for surgical and medical care
 shall  not  exclude coverage for surgical and medical care for diagnosis
 and treatment of correctable medical conditions otherwise covered by the
 policy solely because the medical condition results  in  infertility[.];
 PROVIDED, HOWEVER THAT:
   (I)  SUBJECT  TO THE PROVISIONS OF SUBPARAGRAPH (C) OF THIS PARAGRAPH,
 IN NO CASE SHALL SUCH COVERAGE EXCLUDE SURGICAL  OR  MEDICAL  PROCEDURES
 PROVIDED AS PART OF SUCH HOSPITAL CARE WHICH WOULD CORRECT MALFORMATION,
 DISEASE OR DYSFUNCTION RESULTING IN INFERTILITY; AND
   (II)  PROVIDED,  FURTHER  HOWEVER,  THAT  SUBJECT TO THE PROVISIONS OF
 SUBPARAGRAPH (C) OF THIS PARAGRAPH,  IN  NO  CASE  SHALL  SUCH  COVERAGE
 EXCLUDE  DIAGNOSTIC TESTS AND PROCEDURES PROVIDED AS PART OF SUCH HOSPI-
 TAL CARE THAT ARE NECESSARY TO DETERMINE INFERTILITY OR THAT ARE  NECES-
 SARY   IN   CONNECTION  WITH  ANY  SURGICAL  OR  MEDICAL  TREATMENTS  OR
 PRESCRIPTION DRUG COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH,  INCLUD-
 ING SUCH DIAGNOSTIC TESTS AND PROCEDURES AS HYSTEROSALPINGOGRAM, HYSTER-
 OSCOPY,  ENDOMETRIAL  BIOPSY, LAPAROSCOPY, SONO-HYSTEROGRAM, POST COITAL
 TESTS, TESTIS BIOPSY, SEMEN ANALYSIS, BLOOD TESTS, ULTRASOUND, OVULATION
 INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO FERTILIZATION, INTRACYTO-
 PLASMIC SPERM INJECTION, UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER,  GAMETE
 INTRA-FALLOPIAN  TRANSFER,  ZYGOTE  INTRA-FALLOPIAN  TRANSFER, LOW TUBAL
 OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM; AND
   (III) PROVIDED, FURTHER HOWEVER,  EVERY  SUCH  POLICY  WHICH  PROVIDES
 COVERAGE  FOR  PRESCRIPTION  DRUGS  SHALL INCLUDE, WITHIN SUCH COVERAGE,
 COVERAGE FOR PRESCRIPTION DRUGS APPROVED BY THE FEDERAL  FOOD  AND  DRUG
 ADMINISTRATION  FOR USE IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY IN
 ACCORDANCE WITH SUBPARAGRAPH (C) OF THIS PARAGRAPH.
   (C)  COVERAGE  OF  DIAGNOSTIC  AND  TREATMENT  PROCEDURES,   INCLUDING
 PRESCRIPTION  DRUGS,  USED IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY
 AS REQUIRED BY SUBPARAGRAPHS (A) AND (B)  OF  THIS  PARAGRAPH  SHALL  BE
 PROVIDED IN ACCORDANCE WITH THE PROVISIONS OF THIS SUBPARAGRAPH.
   (I) COVERAGE SHALL BE PROVIDED FOR PERSONS WHOSE AGES RANGE FROM TWEN-
 TY-ONE  THROUGH  FORTY-FOUR  YEARS OF AGE, PROVIDED THAT NOTHING IN THIS
 SUBPARAGRAPH SHALL PRECLUDE THE PROVISION OF COVERAGE TO  PERSONS  WHOSE
 AGE IS BELOW OR ABOVE SUCH RANGE.
   (II)  DIAGNOSIS  AND  TREATMENT  OF INFERTILITY SHALL BE PRESCRIBED AS
 PART OF A PHYSICIAN'S OVERALL PLAN  OF  CARE  AND  CONSISTENT  WITH  THE
 GUIDELINES FOR COVERAGE AS REFERENCED IN THIS SUBPARAGRAPH.
   (III)  COVERAGE MAY BE SUBJECT TO CO-PAYMENTS, COINSURANCE AND DEDUCT-
 IBLES AS MAY BE DEEMED APPROPRIATE BY  THE  SUPERINTENDENT  AND  AS  ARE
 CONSISTENT  WITH  THOSE  ESTABLISHED  FOR  OTHER BENEFITS WITHIN A GIVEN
 POLICY.
   (IV) COVERAGE SHALL BE LIMITED TO  THOSE  INDIVIDUALS  WHO  HAVE  BEEN
 PREVIOUSLY COVERED UNDER THE POLICY FOR A PERIOD OF NOT LESS THAN TWELVE
 MONTHS,  PROVIDED  THAT FOR THE PURPOSES OF THIS SUBPARAGRAPH "PERIOD OF
 NOT LESS THAN TWELVE MONTHS" SHALL BE  DETERMINED  BY  CALCULATING  SUCH
 TIME FROM EITHER THE DATE THE INSURED WAS FIRST COVERED UNDER THE EXIST-
 ING POLICY OR FROM THE DATE THE INSURED WAS FIRST COVERED BY A PREVIOUS-
 LY IN-FORCE CONVERTED POLICY, WHICHEVER IS EARLIER.

 A. 2415                             3
 
   (V) COVERAGE SHALL NOT BE REQUIRED TO INCLUDE THE DIAGNOSIS AND TREAT-
 MENT OF INFERTILITY IN CONNECTION WITH:
   (I) THE REVERSAL OF ELECTIVE STERILIZATIONS;
   (II) SEX CHANGE PROCEDURES;
   (III) CLONING; OR
   (IV)  MEDICAL OR SURGICAL SERVICES OR PROCEDURES THAT ARE DEEMED TO BE
 EXPERIMENTAL IN ACCORDANCE WITH CLINICAL GUIDELINES REFERENCED IN CLAUSE
 (VI) OF THIS SUBPARAGRAPH.
   (VI) THE SUPERINTENDENT, IN  CONSULTATION  WITH  THE  COMMISSIONER  OF
 HEALTH,  SHALL  PROMULGATE  REGULATIONS WHICH SHALL STIPULATE THE GUIDE-
 LINES AND STANDARDS WHICH SHALL BE USED IN CARRYING OUT  THE  PROVISIONS
 OF THIS SUBPARAGRAPH, WHICH SHALL INCLUDE:
   (I)  THE  DETERMINATION OF "INFERTILITY" IN ACCORDANCE WITH THE STAND-
 ARDS AND GUIDELINES ESTABLISHED AND ADOPTED BY THE AMERICAN  COLLEGE  OF
 OBSTETRICIANS  AND  GYNECOLOGISTS AND THE AMERICAN SOCIETY FOR REPRODUC-
 TIVE MEDICINE;
   (II) THE IDENTIFICATION OF EXPERIMENTAL PROCEDURES AND TREATMENTS  NOT
 COVERED  FOR  THE  DIAGNOSIS  AND TREATMENT OF INFERTILITY DETERMINED IN
 ACCORDANCE WITH THE STANDARDS AND GUIDELINES ESTABLISHED AND ADOPTED  BY
 THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS AND THE AMERICAN
 SOCIETY FOR REPRODUCTIVE MEDICINE;
   (III)  THE  IDENTIFICATION  OF  THE  REQUIRED TRAINING, EXPERIENCE AND
 OTHER STANDARDS FOR HEALTH CARE PROVIDERS FOR THE  PROVISION  OF  PROCE-
 DURES  AND  TREATMENTS  FOR  THE  DIAGNOSIS AND TREATMENT OF INFERTILITY
 DETERMINED IN ACCORDANCE WITH THE STANDARDS AND  GUIDELINES  ESTABLISHED
 AND  ADOPTED  BY THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
 AND THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE; AND
   (IV) THE DETERMINATION OF APPROPRIATE MEDICAL CANDIDATES BY THE TREAT-
 ING PHYSICIAN IN ACCORDANCE WITH THE  STANDARDS  AND  GUIDELINES  ESTAB-
 LISHED AND ADOPTED BY THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOL-
 OGISTS AND/OR THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE.
   (VII)  A  POLICY  PROVIDING COVERAGE UNDER THIS PARAGRAPH MAY HAVE THE
 FOLLOWING REQUIREMENTS AND LIMITATIONS:
   (I) LIMIT COVERAGE FOR IN-VITRO FERTILIZATION, GAMETE  INTRA-FALLOPIAN
 TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANSFER AND LOW TUBAL OVUM TRANSFER TO
 THOSE INDIVIDUALS WHO HAVE BEEN UNABLE TO CONCEIVE OR PRODUCE CONCEPTION
 OR  SUSTAIN  A SUCCESSFUL PREGNANCY THROUGH LESS EXPENSIVE AND MEDICALLY
 VIABLE INFERTILITY TREATMENT OR PROCEDURES COVERED UNDER SUCH A POLICY;
   (II) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO DENY THE  COVER-
 AGE  REQUIRED BY THIS SECTION TO ANY INDIVIDUAL WHO FORGOES A PARTICULAR
 INFERTILITY TREATMENT OR PROCEDURE IF THE INDIVIDUAL'S PHYSICIAN  DETER-
 MINES THAT SUCH A TREATMENT OR PROCEDURE IS LIKELY TO BE UNSUCCESSFUL;
   (III) LIMIT COVERAGE TO A LIFETIME CAP OF ONE HUNDRED THOUSAND DOLLARS
 FOR  OVULATION INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO FERTILIZA-
 TION, INTRACYTOPLASMIC SPERM INJECTION, UTERINE  EMBRYO  LAVAGE,  EMBRYO
 TRANSFER, GAMETE INTRA-FALLOPIAN TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANS-
 FER, LOW TUBAL OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM;
   (IV)  REQUIRE  DISCLOSURE  BY  THE INDIVIDUAL SEEKING SUCH COVERAGE TO
 SUCH INDIVIDUAL'S EXISTING HEALTH  INSURANCE  CARRIER  OF  ANY  PREVIOUS
 INFERTILITY  TREATMENT  OR PROCEDURES FOR WHICH SUCH INDIVIDUAL RECEIVED
 COVERAGE UNDER A DIFFERENT  HEALTH  INSURANCE  POLICY.  SUCH  DISCLOSURE
 SHALL BE MADE ON A FORM AND IN THE MANNER PRESCRIBED BY THE COMMISSIONER
 OF THE DEPARTMENT OF FINANCIAL SERVICES.
   §  2.  Subparagraphs (A), (B) and (C) of paragraph 6 of subsection (k)
 of section 3221 of the insurance law, as amended by section 1 of part  K
 of chapter 82 of the laws of 2002, are amended to read as follows:

 A. 2415                             4
 
   (A)  Every  group  policy  issued  or  delivered  in  this state which
 provides coverage for hospital  care  shall  not  exclude  coverage  for
 hospital  care for diagnosis and treatment of correctable medical condi-
 tions [otherwise covered by  the  policy]  solely  because  the  medical
 condition results in infertility; provided, however that:
   (i)  subject  to the provisions of subparagraph (C) of this paragraph,
 in no case shall such coverage exclude surgical  or  medical  procedures
 provided as part of such hospital care which would correct malformation,
 disease or dysfunction resulting in infertility; and
   (ii)  provided,  further  however,  that  subject to the provisions of
 subparagraph (C) of this paragraph,  in  no  case  shall  such  coverage
 exclude  diagnostic tests and procedures provided as part of such hospi-
 tal care that are necessary to determine infertility or that are  neces-
 sary   in   connection  with  any  surgical  or  medical  treatments  or
 prescription drug coverage provided pursuant to this paragraph,  includ-
 ing such diagnostic tests and procedures as hysterosalpingogram, hyster-
 oscopy,  endometrial  biopsy, laparoscopy, sono-hysterogram, post coital
 tests, testis biopsy, semen analysis,  blood  tests  [and],  ultrasound,
 OVULATION  INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO FERTILIZATION,
 INTRACYTOPLASMIC SPERM INJECTION, UTERINE EMBRYO LAVAGE,  EMBRYO  TRANS-
 FER,  GAMETE  INTRA-FALLOPIAN TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANSFER,
 LOW TUBAL OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM; and
   (iii) provided, further however,  every  such  policy  which  provides
 coverage  for  prescription  drugs  shall include, within such coverage,
 coverage for prescription drugs approved by the federal  Food  and  Drug
 Administration  for use in the diagnosis and treatment of infertility in
 accordance with subparagraph (C) of this paragraph.
   (B) Every group  policy  issued  or  delivered  in  this  state  which
 provides coverage for surgical and medical care shall not exclude cover-
 age for surgical and medical care for diagnosis and treatment of correc-
 table  medical  conditions  [otherwise  covered  by  the  policy] solely
 because the medical condition results in infertility; provided,  however
 that:
   (i)  subject  to the provisions of subparagraph (C) of this paragraph,
 in no case shall such coverage exclude surgical  or  medical  procedures
 which  would  correct  malformation, disease or dysfunction resulting in
 infertility; and
   (ii) provided, further however, that  subject  to  the  provisions  of
 subparagraph  (C)  of  this  paragraph,  in  no case shall such coverage
 exclude diagnostic tests and procedures that are necessary to  determine
 infertility  or  that  are  necessary in connection with any surgical or
 medical treatments or prescription drug coverage  provided  pursuant  to
 this  paragraph,  including  such  diagnostic  tests  and  procedures as
 hysterosalpingogram,  hysteroscopy,  endometrial  biopsy,   laparoscopy,
 sono-hysterogram,  post  coital  tests,  testis  biopsy, semen analysis,
 blood tests [and], ultrasound, OVULATION INDUCTION, INTRAUTERINE INSEMI-
 NATION,  IN-VITRO  FERTILIZATION,  INTRACYTOPLASMIC   SPERM   INJECTION,
 UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER, GAMETE INTRA-FALLOPIAN TRANSFER,
 ZYGOTE  INTRA-FALLOPIAN  TRANSFER,  LOW TUBAL OVUM TRANSFER, DONOR EGGS,
 AND DONOR SPERM; and
   (iii) provided, further however,  every  such  policy  which  provides
 coverage  for  prescription  drugs  shall include, within such coverage,
 coverage for prescription drugs approved by the federal  Food  and  Drug
 Administration  for use in the diagnosis and treatment of infertility in
 accordance with subparagraph (C) of this paragraph.

 A. 2415                             5
 
   (C)  Coverage  of  diagnostic  and  treatment  procedures,   including
 prescription  drugs,  used in the diagnosis and treatment of infertility
 as required by subparagraphs (A) and (B)  of  this  paragraph  shall  be
 provided in accordance with the provisions of this subparagraph.
   (i) Coverage shall be provided for persons whose ages range from twen-
 ty-one  through  forty-four  years,  provided  that nothing herein shall
 preclude the provision of coverage to persons  whose  age  is  below  or
 above such range.
   (ii)  Diagnosis  and  treatment  of infertility shall be prescribed as
 part of a physician's overall plan  of  care  and  consistent  with  the
 guidelines for coverage as referenced in this subparagraph.
   (iii)  Coverage may be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (iv) Coverage shall be limited to  those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided  that for the purposes of this subparagraph "period of
 not less than twelve months" shall be  determined  by  calculating  such
 time from either the date the insured was first covered under the exist-
 ing policy or from the date the insured was first covered by a previous-
 ly in-force converted policy, whichever is earlier.
   (v) Coverage shall not be required to include the diagnosis and treat-
 ment  of  infertility  in  connection with: (I) [in vitro fertilization,
 gamete intrafallopian  tube  transfers  or  zygote  intrafallopian  tube
 transfers;  (II)]  the reversal of elective sterilizations; [(III)] (II)
 sex change procedures; [(IV)] (III) cloning; or [(V)]  (IV)  medical  or
 surgical  services  or  procedures that are deemed to be experimental in
 accordance with clinical guidelines referenced in clause  (vi)  of  this
 subparagraph.
   (vi)  The  superintendent,  in  consultation  with the commissioner of
 health, shall promulgate regulations which shall  stipulate  the  guide-
 lines  and  standards which shall be used in carrying out the provisions
 of this subparagraph, which shall include:
   (I) The determination of "infertility" in accordance with  the  stand-
 ards  and  guidelines established and adopted by the American College of
 Obstetricians and Gynecologists and the American Society  for  Reproduc-
 tive Medicine;
   (II)  The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   (III) The identification of  the  required  training,  experience  and
 other  standards  for  health care providers for the provision of proce-
 dures and treatments for the  diagnosis  and  treatment  of  infertility
 determined  in  accordance with the standards and guidelines established
 and adopted by the American College of Obstetricians  and  Gynecologists
 and the American Society for Reproductive Medicine; and
   (IV) The determination of appropriate medical candidates by the treat-
 ing  physician  in  accordance  with the standards and guidelines estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.
   (VII) A POLICY PROVIDING COVERAGE UNDER THIS PARAGRAPH  MAY  HAVE  THE
 FOLLOWING REQUIREMENTS AND LIMITATIONS:

 A. 2415                             6
 
   (I)  LIMIT COVERAGE FOR IN-VITRO FERTILIZATION, GAMETE INTRA-FALLOPIAN
 TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANSFER AND LOW TUBAL OVUM TRANSFER TO
 THOSE INDIVIDUALS WHO HAVE BEEN UNABLE TO CONCEIVE OR PRODUCE CONCEPTION
 OR SUSTAIN A SUCCESSFUL PREGNANCY THROUGH LESS EXPENSIVE  AND  MEDICALLY
 VIABLE INFERTILITY TREATMENT OR PROCEDURES COVERED UNDER SUCH A POLICY;
   (II)  NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO DENY THE COVER-
 AGE REQUIRED BY THIS SECTION TO ANY INDIVIDUAL WHO FORGOES A  PARTICULAR
 INFERTILITY  TREATMENT OR PROCEDURE IF THE INDIVIDUAL'S PHYSICIAN DETER-
 MINES THAT SUCH A TREATMENT OR PROCEDURE IS LIKELY TO BE UNSUCCESSFUL;
   (III) LIMIT COVERAGE TO A LIFETIME CAP OF ONE HUNDRED THOUSAND DOLLARS
 FOR OVULATION INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO  FERTILIZA-
 TION,  INTRACYTOPLASMIC  SPERM  INJECTION, UTERINE EMBRYO LAVAGE, EMBRYO
 TRANSFER, GAMETE INTRA-FALLOPIAN TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANS-
 FER, LOW TUBAL OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM;
   (IV) REQUIRE DISCLOSURE BY THE INDIVIDUAL  SEEKING  SUCH  COVERAGE  TO
 SUCH  INDIVIDUAL'S  EXISTING  HEALTH  INSURANCE  CARRIER OF ANY PREVIOUS
 INFERTILITY TREATMENT OR PROCEDURES FOR WHICH SUCH  INDIVIDUAL  RECEIVED
 COVERAGE  UNDER  A  DIFFERENT  HEALTH  INSURANCE POLICY. SUCH DISCLOSURE
 SHALL BE MADE ON A FORM AND IN THE MANNER PRESCRIBED BY THE COMMISSIONER
 OF THE DEPARTMENT OF FINANCIAL SERVICES.
   § 3. Paragraphs 1, 2 and 3 of subsection (s) of section  4303  of  the
 insurance  law,  as  amended by section 2 of part K of chapter 82 of the
 laws of 2002, are amended to read as follows:
   (1) A hospital service corporation or health service corporation which
 provides coverage for hospital  care  shall  not  exclude  coverage  for
 hospital  care for diagnosis and treatment of correctable medical condi-
 tions [otherwise covered by  the  policy]  solely  because  the  medical
 condition results in infertility; provided, however that:
   (A)  subject  to the provisions of paragraph three of this subsection,
 in no case shall such coverage exclude surgical  or  medical  procedures
 provided as part of such hospital care which would correct malformation,
 disease or dysfunction resulting in infertility; and
   (B) provided, further however, that subject to the provisions of para-
 graph  three  of this subsection, in no case shall such coverage exclude
 diagnostic tests and procedures provided as part of such  hospital  care
 that  are  necessary  to  determine infertility or that are necessary in
 connection with any surgical or medical treatments or prescription  drug
 coverage provided pursuant to this subsection, including such diagnostic
 tests  and  procedures as hysterosalpingogram, hysteroscopy, endometrial
 biopsy, laparoscopy, sono-hysterogram, post coital tests, testis biopsy,
 semen analysis, blood  tests  [and],  ultrasound,  OVULATION  INDUCTION,
 INTRAUTERINE   INSEMINATION,  IN-VITRO  FERTILIZATION,  INTRACYTOPLASMIC
 SPERM INJECTION, UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER,  GAMETE  INTRA-
 FALLOPIAN  TRANSFER,  ZYGOTE  INTRA-FALLOPIAN  TRANSFER,  LOW TUBAL OVUM
 TRANSFER, DONOR EGGS, AND DONOR SPERM; and
   (C) provided, further however, every such policy which provides cover-
 age for prescription drugs shall include, within such coverage, coverage
 for prescription drugs approved by the federal Food  and  Drug  Adminis-
 tration for use in the diagnosis and treatment of infertility in accord-
 ance with paragraph three of this subsection.
   (2)  A  medical  expense indemnity or health service corporation which
 provides coverage for surgical and medical care shall not exclude cover-
 age for surgical and medical care for diagnosis and treatment of correc-
 table medical conditions otherwise covered by the policy solely  because
 the medical condition results in infertility; provided, however that:

 A. 2415                             7

   (A)  subject  to the provisions of paragraph three of this subsection,
 in no case shall such coverage exclude surgical  or  medical  procedures
 which  would  correct  malformation, disease or dysfunction resulting in
 infertility; and
   (B) provided, further however, that subject to the provisions of para-
 graph  three  of this subsection, in no case shall such coverage exclude
 diagnostic tests and procedures that are necessary to  determine  infer-
 tility  or that are necessary in connection with any surgical or medical
 treatments or prescription  drug  coverage  provided  pursuant  to  this
 subsection,  including  such diagnostic tests and procedures as hystero-
 salpingogram, hysteroscopy, endometrial biopsy, laparoscopy, sono-hyste-
 rogram, post coital tests, testis biopsy, semen  analysis,  blood  tests
 [and],   ultrasound,  OVULATION  INDUCTION,  INTRAUTERINE  INSEMINATION,
 IN-VITRO FERTILIZATION, INTRACYTOPLASMIC SPERM INJECTION, UTERINE EMBRYO
 LAVAGE, EMBRYO TRANSFER, GAMETE INTRA-FALLOPIAN TRANSFER, ZYGOTE  INTRA-
 FALLOPIAN  TRANSFER,  LOW  TUBAL  OVUM  TRANSFER,  DONOR EGGS, AND DONOR
 SPERM; and
   (C) provided, further however, every such policy which provides cover-
 age for prescription drugs shall include, within such coverage, coverage
 for prescription drugs approved by the federal Food  and  Drug  Adminis-
 tration for use in the diagnosis and treatment of infertility in accord-
 ance with paragraph three of this subsection.
   (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
 prescription drugs used in the diagnosis and treatment of infertility as
 required by paragraphs one and two of this subsection shall be  provided
 in accordance with this paragraph.
   (A) Coverage shall be provided for persons whose ages range from twen-
 ty-one  through  forty-four  years,  provided  that nothing herein shall
 preclude the provision of coverage to persons  whose  age  is  below  or
 above such range.
   (B) Diagnosis and treatment of infertility shall be prescribed as part
 of a physician's overall plan of care and consistent with the guidelines
 for coverage as referenced in this paragraph.
   (C)  Coverage  may  be subject to co-payments, coinsurance and deduct-
 ibles as may be deemed appropriate by  the  superintendent  and  as  are
 consistent  with  those  established  for  other benefits within a given
 policy.
   (D) Coverage shall be limited  to  those  individuals  who  have  been
 previously covered under the policy for a period of not less than twelve
 months,  provided that for the purposes of this paragraph "period of not
 less than twelve months" shall be determined by  calculating  such  time
 from  either  the  date the insured was first covered under the existing
 policy or from the date the insured was first covered  by  a  previously
 in-force converted policy, whichever is earlier.
   (E) Coverage shall not be required to include the diagnosis and treat-
 ment  of  infertility  in  connection with: (i) [in vitro fertilization,
 gamete intrafallopian  tube  transfers  or  zygote  intrafallopian  tube
 transfers;  (ii)]  the reversal of elective sterilizations; [(iii)] (II)
 sex change procedures; [(iv)] (III) cloning; or [(v)]  (IV)  medical  or
 surgical  services  or  procedures that are deemed to be experimental in
 accordance with clinical guidelines referenced in  subparagraph  (F)  of
 this paragraph.
   (F)  The  superintendent,  in  consultation  with  the commissioner of
 health, shall promulgate regulations which shall  stipulate  the  guide-
 lines  and  standards which shall be used in carrying out the provisions
 of this paragraph, which shall include:

 A. 2415                             8
 
   (i) The determination of "infertility" in accordance with  the  stand-
 ards  and  guidelines established and adopted by the American College of
 Obstetricians and Gynecologists and the American Society  for  Reproduc-
 tive Medicine;
   (ii)  The identification of experimental procedures and treatments not
 covered for the diagnosis and treatment  of  infertility  determined  in
 accordance  with the standards and guidelines established and adopted by
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   (iii) The identification of  the  required  training,  experience  and
 other  standards  for  health care providers for the provision of proce-
 dures and treatments for the  diagnosis  and  treatment  of  infertility
 determined  in  accordance with the standards and guidelines established
 and adopted by the American College of Obstetricians  and  Gynecologists
 and the American Society for Reproductive Medicine; and
   (iv) The determination of appropriate medical candidates by the treat-
 ing  physician  in  accordance  with the standards and guidelines estab-
 lished and adopted by the American College of Obstetricians and Gynecol-
 ogists and/or the American Society for Reproductive Medicine.
   (G) A POLICY PROVIDING COVERAGE UNDER THIS  SUBSECTION  MAY  HAVE  THE
 FOLLOWING REQUIREMENTS AND LIMITATIONS:
   (I)  LIMIT COVERAGE FOR IN-VITRO FERTILIZATION, GAMETE INTRA-FALLOPIAN
 TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANSFER AND LOW TUBAL OVUM TRANSFER TO
 THOSE INDIVIDUALS WHO HAVE BEEN UNABLE TO CONCEIVE OR PRODUCE CONCEPTION
 OR SUSTAIN A SUCCESSFUL PREGNANCY THROUGH LESS EXPENSIVE  AND  MEDICALLY
 VIABLE INFERTILITY TREATMENT OR PROCEDURES COVERED UNDER SUCH A POLICY.
   (II)  NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO DENY THE COVER-
 AGE REQUIRED BY THIS SECTION TO ANY INDIVIDUAL WHO FORGOES A  PARTICULAR
 INFERTILITY  TREATMENT OR PROCEDURE IF THE INDIVIDUAL'S PHYSICIAN DETER-
 MINES THAT SUCH A TREATMENT OR PROCEDURE IS LIKELY TO BE UNSUCCESSFUL;
   (III) LIMIT COVERAGE TO A LIFETIME CAP OF ONE HUNDRED THOUSAND DOLLARS
 FOR OVULATION INDUCTION, INTRAUTERINE INSEMINATION, IN-VITRO  FERTILIZA-
 TION,  INTRACYTOPLASMIC  SPERM  INJECTION, UTERINE EMBRYO LAVAGE, EMBRYO
 TRANSFER, GAMETE INTRA-FALLOPIAN TRANSFER, ZYGOTE INTRA-FALLOPIAN TRANS-
 FER, LOW TUBAL OVUM TRANSFER, DONOR EGGS, AND DONOR SPERM;
   (IV) REQUIRE DISCLOSURE BY THE INDIVIDUAL  SEEKING  SUCH  COVERAGE  TO
 SUCH  INDIVIDUAL'S  EXISTING  HEALTH  INSURANCE  CARRIER OF ANY PREVIOUS
 INFERTILITY TREATMENT OR PROCEDURES FOR WHICH SUCH  INDIVIDUAL  RECEIVED
 COVERAGE  UNDER  A  DIFFERENT  HEALTH  INSURANCE POLICY. SUCH DISCLOSURE
 SHALL BE MADE ON A FORM AND IN THE MANNER PRESCRIBED BY THE COMMISSIONER
 OF THE DEPARTMENT OF FINANCIAL SERVICES.
   § 4. This act shall take effect immediately.