S T A T E O F N E W Y O R K
________________________________________________________________________
6118--A
2023-2024 Regular Sessions
I N S E N A T E
March 30, 2023
___________
Introduced by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and
when printed to be committed to the Committee on Insurance -- recom-
mitted to the Committee on Insurance in accordance with Senate Rule 6,
sec. 8 -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to the definition of
infertility and health insurance coverage for in-vitro fertilization
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. This act shall be known and may be cited as "The Equity in
Fertility Treatment Act".
§ 2. Items (v) and (vii) of subparagraph (C) of paragraph 6 of
subsection (k) of section 3221 of the insurance law, as amended by
section 1 of part L of chapter 57 of the laws of 2019, are amended to
read as follows:
(v)(I) For the purposes of this paragraph, "infertility" means a
disease or condition characterized by the incapacity to impregnate
another person or to conceive, defined by (A) the failure to establish a
clinical pregnancy after twelve months of regular, unprotected sexual
intercourse or therapeutic donor insemination, or after six months of
regular, unprotected sexual intercourse or therapeutic donor insemina-
tion for a female thirty-five years of age or older; (B) A PERSON'S
INABILITY TO REPRODUCE EITHER AS A SINGLE INDIVIDUAL OR WITH THEIR PART-
NER WITHOUT MEDICAL INTERVENTION; OR (C) A LICENSED PHYSICIAN'S OR
OSTEOPATHIC PHYSICIAN'S FINDINGS BASED ON A PATIENT'S MEDICAL, SEXUAL,
OR REPRODUCTIVE HISTORY, AGE, PHYSICAL FINDINGS, OR DIAGNOSTIC TESTING.
Earlier evaluation and treatment may be warranted based on an individ-
ual's medical, SEXUAL, OR REPRODUCTIVE history [or], AGE, physical find-
ings, OR DIAGNOSTIC TESTING.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10106-04-3
S. 6118--A 2
(II) For purposes of this paragraph, "iatrogenic infertility" means an
impairment of fertility by surgery, radiation, chemotherapy or other
medical treatment affecting reproductive organs or processes.
(vii) Every large group policy delivered or issued for delivery in
this state that provides medical, major medical or similar comprehen-
sive-type coverage shall provide coverage for three [cycles of]
COMPLETED OOCYTE RETRIEVALS AND in-vitro fertilization [used in the
treatment of infertility] WITH UNLIMITED EMBRYO TRANSFERS FROM FRESH OR
FROZEN OOCYTES OR EMBRYOS FROM A COVERED RETRIEVAL, IN ACCORDANCE WITH
THE GUIDELINES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE, USING
SINGLE EMBRYO TRANSFER (SET) WHEN RECOMMENDED AND MEDICALLY APPROPRIATE
FOR THE TREATMENT OF INFERTILITY. Coverage (I) SHALL NOT BE DENIED BASED
ON A COVERED INDIVIDUAL'S PARTICIPATION IN FERTILITY SERVICES PROVIDED
BY OR TO A THIRD PARTY, AND (II) may be subject to annual deductibles
and coinsurance, including copayments, as may be deemed appropriate by
the superintendent and as are consistent with those established for
other benefits within a given policy. [For purposes of this item, a
"cycle" is defined as either all treatment that starts when: preparatory
medications are administered for ovarian stimulation for oocyte
retrieval with the intent of undergoing in-vitro fertilization using a
fresh embryo transfer; or medications are administered for endometrial
preparation with the intent of undergoing in-vitro fertilization using a
frozen embryo transfer.]
§ 3. Subparagraphs (E) and (G) of paragraph 3 of subsection (s) of
section 4303 of the insurance law, as amended by section 2 of part L of
chapter 57 of the laws of 2019, are amended to read as follows:
(E)(i) For the purposes of this subsection, "infertility" means a
disease or condition characterized by the incapacity to impregnate
another person or to conceive, defined by (A) the failure to establish a
clinical pregnancy after twelve months of regular, unprotected sexual
intercourse or therapeutic donor insemination, or after six months of
regular, unprotected sexual intercourse or therapeutic donor insemina-
tion for a female thirty-five years of age or older; (B) A PERSON'S
INABILITY TO REPRODUCE EITHER AS A SINGLE INDIVIDUAL OR WITH THEIR PART-
NER WITHOUT MEDICAL INTERVENTION; OR (C) A LICENSED PHYSICIAN'S OR
OSTEOPATHIC PHYSICIAN'S FINDINGS BASED ON A PATIENT'S MEDICAL, SEXUAL,
OR REPRODUCTIVE HISTORY, AGE, PHYSICAL FINDINGS, OR DIAGNOSTIC TESTING.
Earlier evaluation and treatment may be warranted based on an individ-
ual's medical history or physical findings.
(ii) For purposes of this subsection, "iatrogenic infertility" means
an impairment of fertility by surgery, radiation, chemotherapy or other
medical treatment affecting reproductive organs or processes.
(G) Every large group contract that provides medical, major medical or
similar comprehensive-type coverage shall provide coverage for three
[cycles of] COMPLETED OOCYTE RETRIEVALS AND in-vitro fertilization [used
in the treatment of infertility] WITH UNLIMITED EMBRYO TRANSFERS FROM
FRESH OR FROZEN OOCYTES OR EMBRYOS FROM A COVERED RETRIEVAL, IN ACCORD-
ANCE WITH THE GUIDELINES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDI-
CINE, USING SINGLE EMBRYO TRANSFER (SET) WHEN RECOMMENDED AND MEDICALLY
APPROPRIATE FOR THE TREATMENT OF INFERTILITY. Coverage (I) SHALL NOT BE
DENIED BASED ON A COVERED INDIVIDUAL'S PARTICIPATION IN FERTILITY
SERVICES PROVIDED BY OR TO A THIRD PARTY, AND (II) may be subject to
annual deductibles and coinsurance, including copayments, as may be
deemed appropriate by the superintendent and as are consistent with
those established for other benefits within a given contract. [For
purposes of this subparagraph, a "cycle" is defined as either all treat-
S. 6118--A 3
ment that starts when: preparatory medications are administered for
ovarian stimulation for oocyte retrieval with the intent of undergoing
in-vitro fertilization using a fresh embryo transfer; or medications are
administered for endometrial preparation with the intent of undergoing
in-vitro fertilization using a frozen embryo transfer.]
§ 4. This act shall take effect immediately.
