Amended IN Assembly May 16, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly April 09, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 767Introduced by Assembly Member Wicks(Principal coauthors: Assembly Members Burke and Low)(Principal coauthor: Senator Stern)February 19, 2019 An act to amend Section 1374.55 of the Health and Safety Code, and to amend Section 10119.6 of the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 767, as amended, Wicks. Health care coverage: essential health benefits: infertility.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.Existing law requires certain group health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 1990, to offer coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. Existing law exempts any employer that is a religious organization or health care service plan or health insurer that is a subsidiary of an entity whose owner or corporate member is a religious organization from the requirement to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would state the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, a requirement that every group health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 1990, offers coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. The Knox-Keene Act specifies that a health care service plan that is a health maintenance organization (HMO) is required to provide this coverage to a group contractholder with at least 20 employees. Existing law provides that any employer that is a religious organization or health care service plans and health insurers that are a subsidiary of an entity whose owner or corporate member is a religious organization shall not be required to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would instead require every large group health care service plan contract, including applicable HMO contracts, or large group disability insurance policy that covers hospital, medical, or surgical expenses, issued, amended, or renewed on or after January 1, 2020, to provide coverage for the treatment of infertility, including a maximum of 3 cycles of in vitro fertilization and mature oocyte cryopreservation, to a lifetime maximum benefit of $75,000 paid at contracted rates per enrollee or insured, as applicable. The bill would delete the exemption for religiously affiliated employers, health care service plans, and health insurance policies from the requirements relating to coverage for the treatment of infertility, thereby imposing these requirements on these employers, plans, and policies that provide coverage for large groups. The bill would also delete the requirement that a health care service plan contract and health insurance policy provide infertility treatment under agreed upon terms that are communicated to all group contractholders and prospective group contractholders. The bill would specifically exclude Medi-Cal coverage from these provisions. By expanding the duties of health care service plans, the bill would expand the scope of an existing crime, thereby imposing a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YESNO Local Program: YESNO Bill TextThe people of the State of California do enact as follows:SECTION 1. It is the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.SECTION 1.Section 1374.55 of the Health and Safety Code is amended to read:1374.55.(a)(1)On and after January 1, 2020, every large group health care service plan contract that is issued, amended, or renewed that covers hospital, medical, or surgical expenses shall provide coverage for the treatment of infertility, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.(2)A large group health care service plan contract shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per enrollee.(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.(c)Consistent with Section 1365.5, coverage for the treatment of infertility shall be provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.(d)The following definitions shall apply for purposes of this section:(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.(3)Large group health care service plan contract means a group health care service plan contract other than a contract issued to a small employer, as defined in Section 1357, 1357.500, or 1357.600.(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.(5)Treatment of infertility means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.(e)This section does not apply to a Medi-Cal managed care plan or any entity that enters into a contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2.Section 10119.6 of the Insurance Code is amended to read:10119.6.(a)(1)On and after January 1, 2020, every insurer issuing, renewing, or amending a policy of large group disability insurance that covers hospital, medical, or surgical expenses shall provide coverage of infertility treatment, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.(2)A large group disability insurance policy shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per insured.(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.(c)This section applies to every disability insurance policy that is issued, amended, or renewed to residents of this state regardless of the situs of the contract.(d)Consistent with Section 10140, coverage of infertility treatment shall be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.(e)The following definitions shall apply for purposes of this section:(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.(3)Large group means a group that is not a small employer, as defined in Section 10753.(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.(5)Coverage of infertility treatment means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.(f)This section does not apply to Medi-Cal contracts with the State Department of Health Care Services.SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
Amended IN Assembly May 16, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly April 09, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 767Introduced by Assembly Member Wicks(Principal coauthors: Assembly Members Burke and Low)(Principal coauthor: Senator Stern)February 19, 2019 An act to amend Section 1374.55 of the Health and Safety Code, and to amend Section 10119.6 of the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 767, as amended, Wicks. Health care coverage: essential health benefits: infertility.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.Existing law requires certain group health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 1990, to offer coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. Existing law exempts any employer that is a religious organization or health care service plan or health insurer that is a subsidiary of an entity whose owner or corporate member is a religious organization from the requirement to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would state the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, a requirement that every group health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 1990, offers coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. The Knox-Keene Act specifies that a health care service plan that is a health maintenance organization (HMO) is required to provide this coverage to a group contractholder with at least 20 employees. Existing law provides that any employer that is a religious organization or health care service plans and health insurers that are a subsidiary of an entity whose owner or corporate member is a religious organization shall not be required to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would instead require every large group health care service plan contract, including applicable HMO contracts, or large group disability insurance policy that covers hospital, medical, or surgical expenses, issued, amended, or renewed on or after January 1, 2020, to provide coverage for the treatment of infertility, including a maximum of 3 cycles of in vitro fertilization and mature oocyte cryopreservation, to a lifetime maximum benefit of $75,000 paid at contracted rates per enrollee or insured, as applicable. The bill would delete the exemption for religiously affiliated employers, health care service plans, and health insurance policies from the requirements relating to coverage for the treatment of infertility, thereby imposing these requirements on these employers, plans, and policies that provide coverage for large groups. The bill would also delete the requirement that a health care service plan contract and health insurance policy provide infertility treatment under agreed upon terms that are communicated to all group contractholders and prospective group contractholders. The bill would specifically exclude Medi-Cal coverage from these provisions. By expanding the duties of health care service plans, the bill would expand the scope of an existing crime, thereby imposing a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YESNO Local Program: YESNO
Amended IN Assembly May 16, 2019 Amended IN Assembly April 30, 2019 Amended IN Assembly April 09, 2019
Amended IN Assembly May 16, 2019
Amended IN Assembly April 30, 2019
Amended IN Assembly April 09, 2019
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill No. 767
Introduced by Assembly Member Wicks(Principal coauthors: Assembly Members Burke and Low)(Principal coauthor: Senator Stern)February 19, 2019
Introduced by Assembly Member Wicks(Principal coauthors: Assembly Members Burke and Low)(Principal coauthor: Senator Stern)
February 19, 2019
An act to amend Section 1374.55 of the Health and Safety Code, and to amend Section 10119.6 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 767, as amended, Wicks. Health care coverage: essential health benefits: infertility.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.Existing law requires certain group health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 1990, to offer coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. Existing law exempts any employer that is a religious organization or health care service plan or health insurer that is a subsidiary of an entity whose owner or corporate member is a religious organization from the requirement to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would state the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, a requirement that every group health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 1990, offers coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. The Knox-Keene Act specifies that a health care service plan that is a health maintenance organization (HMO) is required to provide this coverage to a group contractholder with at least 20 employees. Existing law provides that any employer that is a religious organization or health care service plans and health insurers that are a subsidiary of an entity whose owner or corporate member is a religious organization shall not be required to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.This bill would instead require every large group health care service plan contract, including applicable HMO contracts, or large group disability insurance policy that covers hospital, medical, or surgical expenses, issued, amended, or renewed on or after January 1, 2020, to provide coverage for the treatment of infertility, including a maximum of 3 cycles of in vitro fertilization and mature oocyte cryopreservation, to a lifetime maximum benefit of $75,000 paid at contracted rates per enrollee or insured, as applicable. The bill would delete the exemption for religiously affiliated employers, health care service plans, and health insurance policies from the requirements relating to coverage for the treatment of infertility, thereby imposing these requirements on these employers, plans, and policies that provide coverage for large groups. The bill would also delete the requirement that a health care service plan contract and health insurance policy provide infertility treatment under agreed upon terms that are communicated to all group contractholders and prospective group contractholders. The bill would specifically exclude Medi-Cal coverage from these provisions. By expanding the duties of health care service plans, the bill would expand the scope of an existing crime, thereby imposing a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.
Existing law requires certain group health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 1990, to offer coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. Existing law exempts any employer that is a religious organization or health care service plan or health insurer that is a subsidiary of an entity whose owner or corporate member is a religious organization from the requirement to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.
This bill would state the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of its provisions a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, a requirement that every group health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 1990, offers coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the health care service plans or the health insurers. The Knox-Keene Act specifies that a health care service plan that is a health maintenance organization (HMO) is required to provide this coverage to a group contractholder with at least 20 employees. Existing law provides that any employer that is a religious organization or health care service plans and health insurers that are a subsidiary of an entity whose owner or corporate member is a religious organization shall not be required to offer coverage for forms of treatment of infertility in a manner inconsistent with the religious organizations religious and ethical principles, as specified.
This bill would instead require every large group health care service plan contract, including applicable HMO contracts, or large group disability insurance policy that covers hospital, medical, or surgical expenses, issued, amended, or renewed on or after January 1, 2020, to provide coverage for the treatment of infertility, including a maximum of 3 cycles of in vitro fertilization and mature oocyte cryopreservation, to a lifetime maximum benefit of $75,000 paid at contracted rates per enrollee or insured, as applicable. The bill would delete the exemption for religiously affiliated employers, health care service plans, and health insurance policies from the requirements relating to coverage for the treatment of infertility, thereby imposing these requirements on these employers, plans, and policies that provide coverage for large groups. The bill would also delete the requirement that a health care service plan contract and health insurance policy provide infertility treatment under agreed upon terms that are communicated to all group contractholders and prospective group contractholders. The bill would specifically exclude Medi-Cal coverage from these provisions. By expanding the duties of health care service plans, the bill would expand the scope of an existing crime, thereby imposing a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. It is the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.SECTION 1.Section 1374.55 of the Health and Safety Code is amended to read:1374.55.(a)(1)On and after January 1, 2020, every large group health care service plan contract that is issued, amended, or renewed that covers hospital, medical, or surgical expenses shall provide coverage for the treatment of infertility, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.(2)A large group health care service plan contract shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per enrollee.(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.(c)Consistent with Section 1365.5, coverage for the treatment of infertility shall be provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.(d)The following definitions shall apply for purposes of this section:(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.(3)Large group health care service plan contract means a group health care service plan contract other than a contract issued to a small employer, as defined in Section 1357, 1357.500, or 1357.600.(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.(5)Treatment of infertility means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.(e)This section does not apply to a Medi-Cal managed care plan or any entity that enters into a contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2.Section 10119.6 of the Insurance Code is amended to read:10119.6.(a)(1)On and after January 1, 2020, every insurer issuing, renewing, or amending a policy of large group disability insurance that covers hospital, medical, or surgical expenses shall provide coverage of infertility treatment, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.(2)A large group disability insurance policy shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per insured.(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.(c)This section applies to every disability insurance policy that is issued, amended, or renewed to residents of this state regardless of the situs of the contract.(d)Consistent with Section 10140, coverage of infertility treatment shall be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.(e)The following definitions shall apply for purposes of this section:(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.(3)Large group means a group that is not a small employer, as defined in Section 10753.(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.(5)Coverage of infertility treatment means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.(f)This section does not apply to Medi-Cal contracts with the State Department of Health Care Services.SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. It is the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.
SECTION 1. It is the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.
SECTION 1. It is the intent of the Legislature to consider the inclusion of infertility treatment in the definition of essential health benefits.
### SECTION 1.
(a)(1)On and after January 1, 2020, every large group health care service plan contract that is issued, amended, or renewed that covers hospital, medical, or surgical expenses shall provide coverage for the treatment of infertility, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.
(2)A large group health care service plan contract shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per enrollee.
(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.
(c)Consistent with Section 1365.5, coverage for the treatment of infertility shall be provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.
(d)The following definitions shall apply for purposes of this section:
(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.
(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.
(3)Large group health care service plan contract means a group health care service plan contract other than a contract issued to a small employer, as defined in Section 1357, 1357.500, or 1357.600.
(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.
(5)Treatment of infertility means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.
(e)This section does not apply to a Medi-Cal managed care plan or any entity that enters into a contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, Chapter 8 (commencing with Section 14200) of, or Chapter 8.75 (commencing with Section 14591) of, Part 3 of Division 9 of the Welfare and Institutions Code.
(a)(1)On and after January 1, 2020, every insurer issuing, renewing, or amending a policy of large group disability insurance that covers hospital, medical, or surgical expenses shall provide coverage of infertility treatment, including a maximum of three cycles of in vitro fertilization and mature oocyte cryopreservation.
(2)A large group disability insurance policy shall limit the coverage required by paragraph (1) to a lifetime maximum benefit of seventy-five thousand dollars ($75,000) paid at contracted rates per insured.
(b)This section shall not be construed to deny or restrict in any way any existing right or benefit to coverage and treatment of infertility under an existing law, plan, or policy.
(c)This section applies to every disability insurance policy that is issued, amended, or renewed to residents of this state regardless of the situs of the contract.
(d)Consistent with Section 10140, coverage of infertility treatment shall be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Nothing in this subdivision shall be construed to interfere with the clinical judgment of a physician and surgeon.
(e)The following definitions shall apply for purposes of this section:
(1)Infertility means the presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility.
(2)In vitro fertilization means the laboratory medical procedures involving the in vitro fertilization process.
(3)Large group means a group that is not a small employer, as defined in Section 10753.
(4)Mature oocyte cryopreservation means the procedures consistent with established medical practices, including laboratory medical procedures, involving ovulation induction, egg retrieval, and freezing of the egg.
(5)Coverage of infertility treatment means procedures consistent with established medical practices in the treatment of infertility by a licensed physician and surgeon, including, but not limited to, diagnosis, diagnostic tests, medication, surgery, gamete intrafallopian transfer, and in vitro fertilization.
(f)This section does not apply to Medi-Cal contracts with the State Department of Health Care Services.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.