S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8441
 
                             I N  S E N A T E
 
                                May 7, 2018
                                ___________
 
 Introduced by Sens. PHILLIPS, HELMING -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN  ACT to amend the insurance law, in relation to insurance coverage of
   in vitro fertilization and other fertility preservation treatments
 
   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 is amended by adding three new subparagraphs (C), (D)  and
 (E) to read as follows:
   (C)  EVERY  POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE  SHALL  PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (D) (I) FOR THE  PURPOSES  OF  SUBPARAGRAPH  (C)  OF  THIS  PARAGRAPH,
 "INFERTILITY" MEANS A CONDITION OR DISEASE CHARACTERIZED BY THE INCAPAC-
 ITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II) BY THE FAILURE TO  ESTABLISH  A  CLINICAL  PREGNANCY  AFTER  TWELVE
 MONTHS  OF  REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.
   (II) FOR THE PURPOSES OF SUBPARAGRAPH (C) OF THIS  PARAGRAPH,  "IATRO-
 GENIC  INFERTILITY"  MEANS  AN IMPAIRMENT OF FERTILITY BY SURGERY, RADI-
 ATION, CHEMOTHERAPY OR OTHER MEDICAL  TREATMENT  AFFECTING  REPRODUCTIVE
 ORGANS OR PROCESSES.
   (E) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD04562-05-8

 S. 8441                             2
 
   §  2.  Paragraph  6 of subsection (k) of section 3221 of the insurance
 law is amended by adding three new subparagraphs (E),  (F)  and  (G)  to
 read as follows:
   (E)  EVERY GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES HOSPITAL,  SURGICAL  OR  MEDICAL  COVERAGE  SHALL  PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (F) (I) FOR THE  PURPOSES  OF  SUBPARAGRAPH  (E)  OF  THIS  PARAGRAPH,
 "INFERTILITY" MEANS A CONDITION OR DISEASE CHARACTERIZED BY THE INCAPAC-
 ITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II) BY THE FAILURE TO  ESTABLISH  A  CLINICAL  PREGNANCY  AFTER  TWELVE
 MONTHS  OF  REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.
   (II) FOR THE PURPOSES OF SUBPARAGRAPH (E) OF THIS  PARAGRAPH,  "IATRO-
 GENIC  INFERTILITY"  MEANS  AN IMPAIRMENT OF FERTILITY BY SURGERY, RADI-
 ATION, CHEMOTHERAPY OR OTHER MEDICAL  TREATMENT  AFFECTING  REPRODUCTIVE
 ORGANS OR PROCESSES.
   (G) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   §  3.  Subsection (s) of section 4303 of the insurance law, as amended
 by section 2 of part F of chapter 82 of the laws of 2002, is amended  by
 adding three new paragraphs 5, 6 and 7 to read as follows:
   (5)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
 HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION FOR  DELIVERY
 IN THIS STATE THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
 PROVIDE COVERAGE FOR:
   (A) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (B)  STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (6) (A) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "INFER-
 TILITY"  MEANS A CONDITION OR DISEASE CHARACTERIZED BY THE INCAPACITY TO
 IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETERMINED (I)
 BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR  (II)  BY
 THE  FAILURE  TO  ESTABLISH  A CLINICAL PREGNANCY AFTER TWELVE MONTHS OF
 REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS OF REGULAR,
 UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIRTY-FIVE YEARS
 OF AGE OR OLDER.
   (B) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "IATROGENIC
 INFERTILITY" MEANS AN IMPAIRMENT OF  FERTILITY  BY  SURGERY,  RADIATION,
 CHEMOTHERAPY OR OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE ORGANS OR
 PROCESSES.
   (7)  NO MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE CORPO-
 RATION OR HEALTH  SERVICE  CORPORATION  PROVIDING  COVERAGE  UNDER  THIS
 SUBSECTION  SHALL  DISCRIMINATE BASED ON A COVERED INDIVIDUAL'S EXPECTED
 LENGTH OF LIFE, PRESENT  OR  PREDICTED  DISABILITY,  DEGREE  OF  MEDICAL
 DEPENDENCY,  PERCEIVED  QUALITY OF LIFE, OR OTHER HEALTH CONDITIONS, NOR

 S. 8441                             3
 
 BASED ON PERSONAL CHARACTERISTICS, INCLUDING  AGE,  SEX,  SEXUAL  ORIEN-
 TATION, MARITAL STATUS OR GENDER IDENTITY.
   § 4. Subparagraph (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, is amended to read as follows:
   (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
 twenty-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)]  (II)  Coverage may be subject to co-payments, coinsurance and
 deductibles 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)] (III) Coverage shall not be required to include the diagnosis and
 treatment  of  infertility  in connection with: (I) [in vitro fertiliza-
 tion, 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)] (IV) of
 this subparagraph.
   [(vi)] (IV) 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)]  (II)  The identification of the required training, experience
 and other standards for health  care  providers  for  the  provision  of
 procedures 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)]  (III)  The  determination of appropriate medical candidates by
 the treating physician in accordance with the standards  and  guidelines

 S. 8441                             4
 
 established  and  adopted  by  the American College of Obstetricians and
 Gynecologists and/or the American Society for Reproductive Medicine.
   §  5.  Paragraph  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, is amended to read as follows:
   (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
 twenty-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)] (B) Coverage may be  subject  to  co-payments,  coinsurance  and
 deductibles  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)] (C) Coverage shall not be required to include the  diagnosis  and
 treatment  of  infertility  in connection with: (i) [in vitro fertiliza-
 tion, 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)] (D)
 of this paragraph.
   [(F)] (D) 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:
   (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)] (II) The identification of the required  training,  experience
 and  other  standards  for  health  care  providers for the provision of
 procedures 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)] (III) The determination of appropriate  medical  candidates  by
 the  treating  physician in accordance with the standards and guidelines

 S. 8441                             5
 
 established and adopted by the American  College  of  Obstetricians  and
 Gynecologists and/or the American Society for Reproductive Medicine.
   § 6. This act shall take effect January 5, 2019 and shall apply to all
 policies issued, renewed, altered or modified on or after such date.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8441--B
 
                             I N  S E N A T E
 
                                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:
 
   Section  1.  Paragraph  13  of  subsection  (i) of section 3216 of the
 insurance law is amended by adding three new subparagraphs (C), (D)  and
 (E) to read as follows:
   (C)  EVERY  POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT
 PROVIDES COVERAGE FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE A
 MAXIMUM LIFETIME LIMIT OF FIFTY THOUSAND DOLLARS COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (D) FOR THE PURPOSES OF SUBPARAGRAPH (C) OF THIS PARAGRAPH:
   (I)  "INFERTILITY"  MEANS  A CONDITION OR DISEASE CHARACTERIZED BY THE
 INCAPACITY TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED  OR
 DETERMINED  (I)  BY  A  PHYSICIAN  LICENSED TO PRACTICE MEDICINE IN THIS
 STATE, OR (II) BY THE FAILURE TO ESTABLISH A  CLINICAL  PREGNANCY  AFTER
 TWELVE  MONTHS  OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX
 MONTHS OF REGULAR, UNPROTECTED SEXUAL  INTERCOURSE  IN  THE  CASE  OF  A
 FEMALE OVER AGE THIRTY-FIVE.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04562-13-8
              

 S. 8441--B                          2
 
   (II)  "IATROGENIC  INFERTILITY"  MEANS  AN  IMPAIRMENT OF FERTILITY BY
 SURGERY, RADIATION, CHEMOTHERAPY OR OTHER  MEDICAL  TREATMENT  AFFECTING
 REPRODUCTIVE ORGANS OR PROCESSES.
   (III)  COVERAGE  FOR  PRESCRIPTION DRUGS NECESSARY AS PART OF IN VITRO
 FERTILIZATION OR STANDARD FERTILITY PRESERVATION SERVICES IS ONLY AVAIL-
 ABLE WHERE THE  POLICY  OTHERWISE  PROVIDES  COVERAGE  FOR  PRESCRIPTION
 DRUGS.
   (IV)  NOTWITHSTANDING  ANY OTHER PROVISION OF LAW, A POLICY MAY IMPOSE
 COST SHARING, DEDUCTIBLES OR COINSURANCE  OBLIGATIONS  THAT  EXCEED  THE
 DOLLAR  AMOUNT  OF  COST SHARING, DEDUCTIBLES OR COINSURANCE OBLIGATIONS
 FOR NON-PREFERRED BRAND NAME DRUGS OR THEIR EQUIVALENT.
   (E) FOR SERVICES PROVIDED PURSUANT TO SUBPARAGRAPH (C) OF  THIS  PARA-
 GRAPH, POLICIES MAY:
   (I)  REQUIRE  THAT SERVICES BE PERFORMED BY CLINICS OR MEDICAL CENTERS
 THAT CONFORM TO GUIDELINES ISSUED BY THE AMERICAN SOCIETY FOR  REPRODUC-
 TIVE MEDICINE OR THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
 (ACOG);
   (II)  REQUIRE, NOTWITHSTANDING NETWORK ADEQUACY REQUIREMENTS, THAT ALL
 SERVICES BE PERFORMED AT DESIGNATED PROVIDERS IDENTIFIED BY THE  INSURER
 AS  MEETING  SPECIFIED  CREDENTIALING  AND  QUALITY  STANDARDS AND WHICH
 PARTICIPATE IN THE INSURER'S PROVIDER NETWORK;
   (III) LIMIT COVERAGE FOR IN VITRO FERTILIZATION TO  THOSE  INDIVIDUALS
 WHO  HAVE  BEEN  UNABLE  TO  CONCEIVE OR PRODUCE CONCEPTION THROUGH LESS
 EXPENSIVE AND  MEDICALLY  VIABLE  INFERTILITY  TREATMENT  OR  PROCEDURES
 COVERED UNDER SUCH POLICY. NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED
 TO  DENY  THE  COVERAGE  REQUIRED  BY THIS SECTION TO ANY INDIVIDUAL WHO
 FOREGOES A PARTICULAR INFERTILITY TREATMENT OR PROCEDURE IF THE INDIVID-
 UAL'S PHYSICIAN DETERMINES THAT SUCH TREATMENT OR PROCEDURE IS LIKELY TO
 BE UNSUCCESSFUL;
   (IV) FOR PURPOSES OF CALCULATING THE LIFETIME LIMIT,  REQUIRE  DISCLO-
 SURE BY THE INDIVIDUAL SEEKING SUCH COVERAGE TO SUCH INDIVIDUAL'S EXIST-
 ING  HEALTH  INSURANCE  CARRIER OF ANY PREVIOUS INFERTILITY TREATMENT OR
 PROCEDURES FOR WHICH SUCH INDIVIDUAL RECEIVED COVERAGE UNDER A DIFFERENT
 HEALTH INSURANCE POLICY ISSUED BY THE SAME INSURER OR BY ANOTHER  INSUR-
 ER; OR
   (V)  LIMIT  COVERAGE  RELATED  TO  IN  VITRO FERTILIZATION SERVICES TO
 PERSONS WHOSE AGES RANGE FROM TWENTY-ONE THROUGH FORTY-FOUR YEARS.
   § 2. Paragraph 6 of subsection (k) of section 3221  of  the  insurance
 law is amended by adding four new subparagraphs (E), (F), (G) and (H) to
 read as follows:
   (E)  EVERY GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL  COVERAGE  SHALL  PROVIDE  A
 MAXIMUM LIFETIME LIMIT OF FIFTY THOUSAND DOLLARS OF COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (F) FOR THE PURPOSES OF SUBPARAGRAPH (E) OF THIS PARAGRAPH:
   (I) "INFERTILITY" MEANS A CONDITION OR DISEASE  CHARACTERIZED  BY  THE
 INCAPACITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR
 DETERMINED (I) BY A PHYSICIAN LICENSED  TO  PRACTICE  MEDICINE  IN  THIS
 STATE,  OR  (II)  BY THE FAILURE TO ESTABLISH A CLINICAL PREGNANCY AFTER
 TWELVE MONTHS OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR  AFTER  SIX
 MONTHS  OF  REGULAR,  UNPROTECTED  SEXUAL  INTERCOURSE  IN THE CASE OF A
 FEMALE OVER AGE THIRTY-FIVE.

 S. 8441--B                          3
 
   (II) "IATROGENIC INFERTILITY" MEANS  AN  IMPAIRMENT  OF  FERTILITY  BY
 SURGERY,  RADIATION,  CHEMOTHERAPY  OR OTHER MEDICAL TREATMENT AFFECTING
 REPRODUCTIVE ORGANS OR PROCESSES.
   (III)  COVERAGE  FOR  PRESCRIPTION DRUGS NECESSARY AS PART OF IN VITRO
 FERTILIZATION OR STANDARD FERTILITY PRESERVATION SERVICES IS ONLY AVAIL-
 ABLE WHERE THE  POLICY  OTHERWISE  PROVIDES  COVERAGE  FOR  PRESCRIPTION
 DRUGS.
   (IV)  NOTWITHSTANDING  ANY OTHER PROVISION OF LAW, A POLICY MAY IMPOSE
 COST SHARING, DEDUCTIBLES OR COINSURANCE  OBLIGATIONS  THAT  EXCEED  THE
 DOLLAR  AMOUNT  OF  COST SHARING, DEDUCTIBLES OR COINSURANCE OBLIGATIONS
 FOR NON-PREFERRED BRAND NAME DRUGS OR THEIR EQUIVALENT.
   (G) NOTWITHSTANDING ANY OTHER PROVISION OF THIS  SUBSECTION,  A  RELI-
 GIOUS  EMPLOYER  MAY  REQUEST  A  CONTRACT WITHOUT COVERAGE FOR IN VITRO
 FERTILIZATION USED IN THE TREATMENT OF INFERTILITY AND STANDARD FERTILI-
 TY PRESERVATION SERVICES THAT ARE CONTRARY TO THE  RELIGIOUS  EMPLOYER'S
 RELIGIOUS TENETS. IF SO REQUESTED, SUCH CONTRACT SHALL BE PROVIDED WITH-
 OUT COVERAGE FOR SERVICES.
   (I) FOR PURPOSES OF THIS SUBSECTION, A "RELIGIOUS EMPLOYER" IS A GROUP
 OR ENTITY FOR WHICH EACH OF THE FOLLOWING IS TRUE:
   (I) THE INCULCATION OF RELIGIOUS VALUES IS THE PURPOSE OF THE GROUP OR
 ENTITY.
   (II) THE GROUP OR ENTITY PRIMARILY EMPLOYS PERSONS WHO SHARE THE RELI-
 GIOUS TENETS OF THE GROUP OR ENTITY.
   (III) THE GROUP OR ENTITY SERVES PRIMARILY PERSONS WHO SHARE THE RELI-
 GIOUS TENETS OF THE GROUP OR ENTITY.
   (IV)  THE  GROUP OR ENTITY IS A NONPROFIT ORGANIZATION AS DESCRIBED IN
 SECTION 6033(A)(2)(A)I OR III, OF THE INTERNAL REVENUE CODE OF 1986,  AS
 AMENDED.
   (II)  EVERY  RELIGIOUS  EMPLOYER  THAT  INVOKES THE EXEMPTION PROVIDED
 UNDER THIS SUBPARAGRAPH SHALL  PROVIDE  WRITTEN  NOTICE  TO  PROSPECTIVE
 ENROLLEES  PRIOR  TO  ENROLLMENT WITH THE PLAN, LISTING THE TREATMENT OF
 INFERTILITY AND STANDARD FERTILITY PRESERVATION  SERVICES  THE  EMPLOYER
 REFUSES TO COVER FOR RELIGIOUS REASONS.
   (H)  FOR  SERVICES PROVIDED PURSUANT TO SUBPARAGRAPH (E) OF THIS PARA-
 GRAPH, POLICIES MAY:
   (I) REQUIRE THAT SERVICES BE PERFORMED BY CLINICS OR  MEDICAL  CENTERS
 THAT  CONFORM TO GUIDELINES ISSUED BY THE AMERICAN SOCIETY FOR REPRODUC-
 TIVE MEDICINE OR THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
 (ACOG);
   (II) REQUIRE, NOTWITHSTANDING NETWORK ADEQUACY REQUIREMENTS, THAT  ALL
 SERVICES  BE PERFORMED AT DESIGNATED PROVIDERS IDENTIFIED BY THE INSURER
 AS MEETING SPECIFIED  CREDENTIALING  AND  QUALITY  STANDARDS  AND  WHICH
 PARTICIPATE IN THE INSURER'S PROVIDER NETWORK;
   (III)  LIMIT  COVERAGE FOR IN VITRO FERTILIZATION TO THOSE INDIVIDUALS
 WHO HAVE BEEN UNABLE TO CONCEIVE  OR  PRODUCE  CONCEPTION  THROUGH  LESS
 EXPENSIVE  AND  MEDICALLY  VIABLE  INFERTILITY  TREATMENT  OR PROCEDURES
 COVERED UNDER SUCH POLICY. NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED
 TO DENY THE COVERAGE REQUIRED BY THIS  SECTION  TO  ANY  INDIVIDUAL  WHO
 FOREGOES A PARTICULAR INFERTILITY TREATMENT OR PROCEDURE IF THE INDIVID-
 UAL'S PHYSICIAN DETERMINES THAT SUCH TREATMENT OR PROCEDURE IS LIKELY TO
 BE UNSUCCESSFUL;
   (IV)  FOR  PURPOSES OF CALCULATING THE LIFETIME LIMIT, REQUIRE DISCLO-
 SURE BY THE INDIVIDUAL SEEKING SUCH COVERAGE TO SUCH INDIVIDUAL'S EXIST-
 ING HEALTH INSURANCE CARRIER OF ANY PREVIOUS  INFERTILITY  TREATMENT  OR
 PROCEDURES FOR WHICH SUCH INDIVIDUAL RECEIVED COVERAGE UNDER A DIFFERENT

 S. 8441--B                          4
 
 HEALTH  INSURANCE POLICY ISSUED BY THE SAME INSURER OR BY ANOTHER INSUR-
 ER; OR
   (V)  LIMIT  COVERAGE  RELATED  TO  IN  VITRO FERTILIZATION SERVICES TO
 PERSONS WHOSE AGES RANGE FROM TWENTY-ONE THROUGH FORTY-FOUR YEARS.
   § 3. Subsection (s) of section 4303 of the insurance law,  as  amended
 by  section 2 of part F of chapter 82 of the laws of 2002, is amended by
 adding four new paragraphs 5, 6, 7 and 8 to read as follows:
   (5) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY  CORPORATION,
 HOSPITAL  SERVICE CORPORATION OR HEALTH SERVICE CORPORATION FOR DELIVERY
 IN THIS STATE THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
 PROVIDE A MAXIMUM LIFETIME LIMIT OF FIFTY THOUSAND DOLLARS  OF  COVERAGE
 FOR:
   (A) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (B)  STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (6) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION:
   (A)  "INFERTILITY"  MEANS  A CONDITION OR DISEASE CHARACTERIZED BY THE
 INCAPACITY TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED  OR
 DETERMINED  (I)  BY  A  PHYSICIAN  LICENSED TO PRACTICE MEDICINE IN THIS
 STATE, OR (II) BY THE FAILURE TO ESTABLISH A  CLINICAL  PREGNANCY  AFTER
 TWELVE  MONTHS  OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX
 MONTHS OF REGULAR, UNPROTECTED SEXUAL  INTERCOURSE  IN  THE  CASE  OF  A
 FEMALE OVER AGE THIRTY-FIVE.
   (B)  "IATROGENIC  INFERTILITY"  MEANS  AN  IMPAIRMENT  OF FERTILITY BY
 SURGERY, RADIATION, CHEMOTHERAPY OR OTHER  MEDICAL  TREATMENT  AFFECTING
 REPRODUCTIVE ORGANS OR PROCESSES.
   (C)  COVERAGE  FOR  PRESCRIPTION  DRUGS  NECESSARY AS PART OF IN VITRO
 FERTILIZATION OR STANDARD FERTILITY PRESERVATION SERVICES IS ONLY AVAIL-
 ABLE WHERE THE  POLICY  OTHERWISE  PROVIDES  COVERAGE  FOR  PRESCRIPTION
 DRUGS.
   (D)  NOTWITHSTANDING  ANY  OTHER PROVISION OF LAW, A POLICY MAY IMPOSE
 COST SHARING, DEDUCTIBLES OR COINSURANCE  OBLIGATIONS  THAT  EXCEED  THE
 DOLLAR  AMOUNT  OF  COST SHARING, DEDUCTIBLES OR COINSURANCE OBLIGATIONS
 FOR NON-PREFERRED BRAND NAME DRUGS OR THEIR EQUIVALENT.
   (7) NOTWITHSTANDING ANY OTHER PROVISION OF THIS  SUBSECTION,  A  RELI-
 GIOUS  EMPLOYER  MAY  REQUEST  A  CONTRACT WITHOUT COVERAGE FOR IN VITRO
 FERTILIZATION USED IN THE TREATMENT OF INFERTILITY AND STANDARD FERTILI-
 TY PRESERVATION SERVICES THAT ARE CONTRARY TO THE  RELIGIOUS  EMPLOYER'S
 RELIGIOUS TENETS. IF SO REQUESTED, SUCH CONTRACT SHALL BE PROVIDED WITH-
 OUT COVERAGE FOR SERVICES.
   (A) FOR PURPOSES OF THIS SUBSECTION, A "RELIGIOUS EMPLOYER" IS A GROUP
 OR ENTITY FOR WHICH EACH OF THE FOLLOWING IS TRUE:
   (I) THE INCULCATION OF RELIGIOUS VALUES IS THE PURPOSE OF THE GROUP OR
 ENTITY.
   (II) THE GROUP OR ENTITY PRIMARILY EMPLOYS PERSONS WHO SHARE THE RELI-
 GIOUS TENETS OF THE GROUP OR ENTITY.
   (III) THE GROUP OR ENTITY SERVES PRIMARILY PERSONS WHO SHARE THE RELI-
 GIOUS TENETS OF THE GROUP OR ENTITY.
   (IV)  THE  GROUP OR ENTITY IS A NONPROFIT ORGANIZATION AS DESCRIBED IN
 SECTION 6033(A)(2)(A)I OR III, OF THE INTERNAL REVENUE CODE OF 1986,  AS
 AMENDED.
   (B) EVERY RELIGIOUS EMPLOYER THAT INVOKES THE EXEMPTION PROVIDED UNDER
 THIS  PARAGRAPH  SHALL  PROVIDE  WRITTEN NOTICE TO PROSPECTIVE ENROLLEES
 PRIOR TO ENROLLMENT WITH THE PLAN, LISTING THE TREATMENT OF  INFERTILITY

 S. 8441--B                          5
 
 AND  STANDARD  FERTILITY  PRESERVATION  SERVICES THE EMPLOYER REFUSES TO
 COVER FOR RELIGIOUS REASONS.
   (8)   FOR  SERVICES  PROVIDED  PURSUANT  TO  PARAGRAPH  FIVE  OF  THIS
 SUBSECTION, POLICIES MAY:
   (A) REQUIRE THAT SERVICES BE PERFORMED BY CLINICS OR  MEDICAL  CENTERS
 THAT  CONFORM TO GUIDELINES ISSUED BY THE AMERICAN SOCIETY FOR REPRODUC-
 TIVE MEDICINE OR THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
 (ACOG);
   (B) REQUIRE, NOTWITHSTANDING NETWORK ADEQUACY REQUIREMENTS,  THAT  ALL
 SERVICES  BE PERFORMED AT DESIGNATED PROVIDERS IDENTIFIED BY THE INSURER
 AS MEETING SPECIFIED  CREDENTIALING  AND  QUALITY  STANDARDS  AND  WHICH
 PARTICIPATE IN THE INSURER'S PROVIDER NETWORK;
   (C) LIMIT COVERAGE FOR IN VITRO FERTILIZATION TO THOSE INDIVIDUALS WHO
 HAVE  BEEN  UNABLE TO CONCEIVE OR PRODUCE CONCEPTION THROUGH LESS EXPEN-
 SIVE AND MEDICALLY VIABLE INFERTILITY TREATMENT  OR  PROCEDURES  COVERED
 UNDER SUCH POLICY. NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO DENY
 THE  COVERAGE  REQUIRED BY THIS SECTION TO ANY INDIVIDUAL WHO FOREGOES A
 PARTICULAR INFERTILITY TREATMENT OR PROCEDURE IF THE INDIVIDUAL'S PHYSI-
 CIAN DETERMINES THAT SUCH TREATMENT OR PROCEDURE IS LIKELY TO BE  UNSUC-
 CESSFUL;
   (D) FOR PURPOSES OF CALCULATING THE LIFETIME LIMIT, REQUIRE DISCLOSURE
 BY  THE  INDIVIDUAL  SEEKING SUCH COVERAGE TO SUCH INDIVIDUAL'S EXISTING
 HEALTH INSURANCE CARRIER OF ANY PREVIOUS INFERTILITY TREATMENT OR PROCE-
 DURES FOR WHICH SUCH INDIVIDUAL  RECEIVED  COVERAGE  UNDER  A  DIFFERENT
 HEALTH  INSURANCE POLICY ISSUED BY THE SAME INSURER OR BY ANOTHER INSUR-
 ER; OR
   (E) LIMIT COVERAGE RELATED  TO  IN  VITRO  FERTILIZATION  SERVICES  TO
 PERSONS WHOSE AGES RANGE FROM TWENTY-ONE THROUGH FORTY-FOUR YEARS.
   § 4. Subparagraph (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, is amended to read as follows:
   (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
 treatment  of  infertility  in connection with: (I) [in vitro fertiliza-
 tion,] gamete intrafallopian tube  transfers  or  zygote  intrafallopian

 S. 8441--B                          6

 tube  transfers; (II) the reversal of elective sterilizations; (III) sex
 change procedures; (IV) cloning; or (V) medical or surgical services  or
 procedures  that  are deemed to be experimental in accordance with clin-
 ical guidelines referenced in clause [(vi)] (V) of this subparagraph.
   [(vi)]  (V)  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.
   §  5.  Paragraph  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, is amended to read as follows:
   (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)]  (D)  Coverage shall not be required to include the diagnosis and
 treatment of infertility in connection with: (i)  [in  vitro  fertiliza-
 tion,]  gamete  intrafallopian  tube  transfers or zygote intrafallopian
 tube transfers; (ii) the reversal of elective sterilizations; (iii)  sex

 S. 8441--B                          7
 
 change  procedures; (iv) cloning; or (v) medical or surgical services or
 procedures that are deemed to be experimental in accordance  with  clin-
 ical guidelines referenced in subparagraph [(F)] (E) of this paragraph.
   [(F)] (E) 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:
   (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.
   §  6.  Section 4 of 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, is amended to read as follows:
   § 4. The commissioner of health, subject to the availability of  funds
 pursuant  to  section 2807-v of the public health law, shall establish a
 program to provide grants to health care providers for  the  purpose  of
 improving  access to infertility services, treatments and procedures. At
 least one such provider shall be located in the city of New York and one
 such provider shall be located in an upstate region.
   Such program shall be targeted to assist individuals  in  meeting  the
 cost  of  infertility services not covered pursuant to sections 3221 and
 4303 of the insurance law as such sections are amended by  sections  one
 and  two  of  this  act  relating  to  expanded  coverage of infertility
 services. Services, treatments and procedures paid for pursuant  to  the
 grant  program  shall be limited to: (A) those who meet the criteria for
 such expanded coverage provided pursuant to the insurance  law  but  for
 whom  the  covered  services are not effective for treating infertility,
 AND THOSE WHO ARE UNABLE TO ACCESS COVERAGE FOR THE EXPANDED  PROCEDURES
 ENACTED PURSUANT TO A CHAPTER OF THE LAWS OF 2018; AND (B) THOSE WHO ARE
 NOT  ENROLLED  IN  A COMMERCIAL HEALTH CARE PLAN BUT WHO WOULD OTHERWISE
 MEET THE CRITERIA OF SUBDIVISION (A) OF THIS SECTION.  Services,  treat-
 ments  and  procedures  paid  for pursuant to the grant program shall be
 further limited to assisted reproductive technology utilizing  in  vitro
 fertilization and gamete intrafallopian tube transfer, and shall be made
 available only in accordance with standards, protocols and other parame-
 ters  as  shall  be established by the commissioner, which shall include
 but not be limited to ASRM and ACOG standards for the appropriateness of
 individuals, providers and treatments, and standards relating  to  cost-
 sharing  based  on income. Services, treatments and procedures under the
 grant program, except for those  specified  herein,  shall  not  include

 S. 8441--B                          8
 
 those  services, treatments and procedures explicitly excluded under the
 expanded coverage provided for  in  the  insurance  law  as  amended  by
 sections  one and two of this act.  Notwithstanding sections 112 and 163
 of  the  state finance law, grants provided pursuant to such program may
 be made without competitive bid or request for proposal.
   The commissioner of health shall  promote  public  awareness  of  this
 program.
   §  7.    The superintendent of financial services in consultation with
 the commissioner of health, shall reassess the coverage requirements  of
 this  act and regulations promulgated thereunder pursuant to a review of
 the comprehensive report funded pursuant to appropriation by chapter  50
 of the laws of 2018 and the request for quote number C000457.
   § 8. This act shall take effect January 1, 2020 and shall apply to all
 policies  issued,  renewed,  altered  or modified on or after such date;
 provided, however, that should this act be determined to  be  a  mandate
 pursuant to section 1311 (d)(3)(B) of the Patient Protection and Afford-
 able  Care Act, then this act shall not apply to coverage offered in the
 individual and small group market unless the  state  appropriates  funds
 sufficient to cover the full cost of such coverage, as determined by the
 department  of financial services and independently verified by an inde-
 pendent actuarial firm certified by the American academy  of  actuaries.
 In  addition,  the  superintendent  of  financial  services shall permit
 insurers and other organizations subject to  this  act  to  establish  a
 minimum  factor  attributable  to  the services covered pursuant to this
 chapter that may be incorporated into rates  for  large  group  policies
 issued  on  or  after January 1, 2020.   Provided further, however, that
 should this act be determined not to be a mandate  pursuant  to  section
 1311(d)(3)(B)  of  the  Patient Protection and Affordable Care Act, then
 the superintendent of financial services shall include in  the  approved
 small  group  and  individual rates a factor attributable to the cost of
 services covered pursuant to this chapter and consistent with the  actu-
 arial  cost,  as projected by the applicant, of such coverage that shall
 be incorporated into rates for policies issued on or  after  January  1,
 2020.