NY State Senate Bill 2023-S6118A

Senate Bill S6118A

2023-2024 Legislative Session

Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 23, 2024	print number 6118a
Feb 23, 2024	amend and recommit to insurance
Jan 03, 2024	referred to insurance
Mar 30, 2023	referred to insurance

Bill Amendments

Original

A (Active)

2023-S6118 - Details

See Assembly Version of this Bill:: A6177
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L

2023-S6118 - Summary

Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.

2023-S6118 - Sponsor Memo

2023-S6118 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6118
 
                        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
 
 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.
   (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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10106-02-3

 S. 6118                             2
 
 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  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  fertiliza-
 tion  using a fresh embryo transfer; or medications are administered for
 endometrial preparation with the intent of undergoing in-vitro  fertili-
 zation 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 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-
 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.

2023-S6118A (ACTIVE) - Details

See Assembly Version of this Bill:: A6177
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L

2023-S6118A (ACTIVE) - Summary

Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.

2023-S6118A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S6118A

SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:

An act to amend the insurance law, in relation to the definition of
infertility and health insurance coverage for in-vitro fertilization

 
PURPOSE:

To ensure that all those wish to become parents through in-vitro ferti-
lization (IVF) may have the coverage to do so by requiring insurance
coverage for donor cycle.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 sets out the title of this act.

Section 2 amends section 3221 of the insurance law to expand IVF cover-
age to include donor cycles.

Section 3 amends section 4303 of the insurance law to expand IVF cover-

age to include donor cycles.

Section 4 provides the effective date.

 
JUSTIFICATION:

The 2019 enacted budget established a requirement for insurance compa-
nies to cover three IVF cycles. The intent was to make the language
non-discriminatory for the LGBTQ+ community. However, key groups were
inadvertently excluded. While the law affords coverage to couples where
one of the partners is using IVF, coverage is unavailable to gay men, as
donor cycles, a key element necessary to obtain an egg, are not covered.
Coverage is therefore also not available for lesbian couples where
neither partner will undergo IVF.

The original 2019 legislation intended to cover three completed cycles
of IVF where one complete cycle begins with either hormone treatment and
retrieval, depending on the needs of the parents, and ends with trans-
fer. However, currently, insurance companies have interpreted a complete
cycle of IVF to only be one phase of the process. For example, insurers
have interpreted retrieval as one completed cycle and transfer as anoth-
er completed cycle. As a result, some couples are left to pay out of
pocket, even when transferring embryos from a covered cycle, or when
additional cycles of IVF are needed, and others must stop their IVF
journey entirely as they cannot afford the care. Further, when transfers
are not properly covered, it serves as an incentive to transfer too many
embryos in one transfer, which is risky and leads to bad medical
outcomes for all involved.

This legislation will ensure that the 2019 law is implemented as
intended by requiring coverage of donor cycles and explicitly stating
that coverage will be provided for three full rounds of IVF, each
including a completed oocyte retrieval and the process of in-vitro
fertilization with unlimited embryo transfers from the covered
retrieval. This legislation will ensure that those who wish to become
parents through IVF, and have the insurance coverage afforded by the
2019 legislation, are able to do so.
 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.

2023-S6118A (ACTIVE) - Bill Text download pdf

                             
                     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.

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