S T A T E O F N E W Y O R K
________________________________________________________________________
2817
2019-2020 Regular Sessions
I N A S S E M B L Y
January 25, 2019
___________
Introduced by M. of A. SIMOTAS, BICHOTTE, QUART, BRONSON, SOLAGES,
BRAUNSTEIN, STECK, SEAWRIGHT, SIMON, PAULIN, BARRETT, HEVESI, LAVINE,
CYMBROWITZ, MOSLEY, BUCHWALD, DINOWITZ, ROZIC, L. ROSENTHAL, OTIS,
LIFTON, JEAN-PIERRE, WRIGHT, WEPRIN, ZEBROWSKI -- Multi-Sponsored by
-- M. of A. ENGLEBRIGHT, LENTOL -- read once and referred 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 DISEASE OR CONDITION 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-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01402-02-9
A. 2817 2
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.
§ 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 DISEASE OR CONDITION 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 K 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 DISEASE OR CONDITION 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.
A. 2817 3
(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
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
A. 2817 4
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
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
A. 2817 5
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
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 on the first day of January next
succeeding the date on which it shall have become a law and shall apply
to all policies issued, renewed, altered or modified on or after such
date.