LCO No. 3110 1 of 7
General Assembly Raised Bill No. 5446
February Session, 2022
LCO No. 3110
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING EQUAL COVERAGE FOR MEDICALLY
NECESSARY INFERTILITY TREATMENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 38a-509 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective January 1, 2023): 2
(a) Subject to the limitations set forth in subsection (b) of this section 3
and except as provided in subsection (c) of this section, each individual 4
health insurance policy providing coverage of the type specified in 5
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, 6
issued for delivery, amended, renewed or continued in this state on or 7
after January 1, [2018] 2023, shall provide coverage for the medically 8
necessary expenses of the diagnosis and treatment of infertility, 9
including, but not limited to, ovulation induction, intrauterine 10
insemination, in-vitro fertilization, uterine embryo lavage, embryo 11
transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer 12
and low tubal ovum transfer. For purposes of this section, "infertility" 13
means [the] a disease, condition [of an individual who is unable to 14
conceive or produce conception or sustain a successful pregnancy 15 Raised Bill No. 5446
LCO No. 3110 2 of 7
during a one-year period or such treatment is medically necessary.] or 16
status characterized by: 17
(1) A failure to conceive or produce conception or sustain a successful 18
pregnancy during a one-year period or such treatment is medically 19
necessary; 20
(2) An individual's inability to reproduce either as a single individual 21
or with a partner without medical intervention; or 22
(3) A licensed physician's findings based on a patient's medical, 23
sexual and reproductive history, age, physical findings or diagnostic 24
testing. 25
(b) Such policy may: 26
(1) Limit such coverage to an individual who fails to conceive or 27
produce conception or sustain a successful pregnancy during a one-year 28
period until the date of such individual's fortieth birthday; 29
(2) Limit such coverage for ovulation induction to a lifetime 30
maximum benefit of four cycles; 31
(3) Limit such coverage for intrauterine insemination to a lifetime 32
maximum benefit of three cycles; 33
(4) Limit lifetime benefits to a maximum of two cycles, with not more 34
than two embryo implantations per cycle, for in-vitro fertilization, 35
gamete intra-fallopian transfer, zygote intra-fallopian transfer or low 36
tubal ovum transfer, provided each such fertilization or transfer shall be 37
credited toward such maximum as one cycle; 38
(5) Limit coverage for in-vitro fertilization, gamete intra-fallopian 39
transfer, zygote intra-fallopian transfer and low tubal ovum transfer to 40
those individuals who have been unable to conceive or produce 41
conception or sustain a successful pregnancy through less expensive 42
and medically viable infertility treatment or procedures covered under 43
such policy. Nothing in this subdivision shall be construed to deny the 44 Raised Bill No. 5446
LCO No. 3110 3 of 7
coverage required by this section to any individual who foregoes a 45
particular infertility treatment or procedure if the individual's physician 46
determines that such treatment or procedure is likely to be unsuccessful; 47
(6) Require that covered infertility treatment or procedures be 48
performed at facilities that conform to the standards and guidelines 49
developed by the American Society of Reproductive Medicine or the 50
Society of Reproductive Endocrinology and Infertility; 51
(7) Limit coverage to individuals who have maintained coverage 52
under such policy for at least twelve months; and 53
(8) Require disclosure by the individual seeking such coverage to 54
such individual's existing health insurance carrier of any previous 55
infertility treatment or procedures for which such individual received 56
coverage under a different health insurance policy. Such disclosure shall 57
be made on a form and in the manner prescribed by the Insurance 58
Commissioner. 59
(c) (1) Any insurance company, hospital service corporation, medical 60
service corporation or health care center may issue to a religious 61
employer an individual health insurance policy that excludes coverage 62
for methods of diagnosis and treatment of infertility that are contrary to 63
the religious employer's bona fide religious tenets. 64
(2) Upon the written request of an individual who states in writing 65
that methods of diagnosis and treatment of infertility are contrary to 66
such individual's religious or moral beliefs, any insurance company, 67
hospital service corporation, medical service corporation or health care 68
center may issue to or on behalf of the individual a policy or rider 69
thereto that excludes coverage for such methods. 70
(d) Any health insurance policy issued pursuant to subsection (c) of 71
this section shall provide written notice to each insured or prospective 72
insured that methods of diagnosis and treatment of infertility are 73
excluded from coverage pursuant to said subsection. Such notice shall 74
appear, in not less than ten-point type, in the policy, application and 75 Raised Bill No. 5446
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sales brochure for such policy. 76
(e) As used in this section, "religious employer" means an employer 77
that is a "qualified church-controlled organization", as defined in 26 USC 78
3121 or a church-affiliated organization. 79
(f) No individual health insurance policy providing coverage of the 80
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 81
delivered, issued for delivery, amended, renewed or continued in this 82
state on or after January 1, 2023, shall discriminate based on an insured's 83
expected length of life, present or predicted disability, degree of medical 84
dependency, perceived quality of life, or other health conditions, or 85
personal characteristics, including age, race, color, religious creed, 86
national origin, sex, sexual orientation, marital status or gender identity. 87
Sec. 2. Section 38a-536 of the general statutes is repealed and the 88
following is substituted in lieu thereof (Effective January 1, 2023): 89
(a) Subject to the limitations set forth in subsection (b) of this section 90
and except as provided in subsection (c) of this section, each group 91
health insurance policy providing coverage of the type specified in 92
subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, 93
issued for delivery, amended, renewed or continued in this state on or 94
after January 1, [2018] 2023, shall provide coverage for the medically 95
necessary expenses of the diagnosis and treatment of infertility, 96
including, but not limited to, ovulation induction, intrauterine 97
insemination, in-vitro fertilization, uterine embryo lavage, embryo 98
transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer 99
and low tubal ovum transfer. For purposes of this section, "infertility" 100
means [the] a disease, condition [of an individual who is unable to 101
conceive or produce conception or sustain a successful pregnancy 102
during a one-year period or such treatment is medically necessary.] or 103
status characterized by: 104
(1) A failure to conceive or produce conception or sustain a successful 105
pregnancy during a one-year period or such treatment is medically 106
necessary; 107 Raised Bill No. 5446
LCO No. 3110 5 of 7
(2) An individual's inability to reproduce either as a single individual 108
or with a partner without medical intervention; or 109
(3) A licensed physician's findings based on a patient's medical, 110
sexual and reproductive history, age, physical findings or diagnostic 111
testing. 112
(b) Such policy may: 113
(1) Limit such coverage to an individual who fails to conceive or 114
produce conception or sustain a successful pregnancy during a one-year 115
period until the date of such individual's fortieth birthday; 116
(2) Limit such coverage for ovulation induction to a lifetime 117
maximum benefit of four cycles; 118
(3) Limit such coverage for intrauterine insemination to a lifetime 119
maximum benefit of three cycles; 120
(4) Limit lifetime benefits to a maximum of two cycles, with not more 121
than two embryo implantations per cycle, for in-vitro fertilization, 122
gamete intra-fallopian transfer, zygote intra-fallopian transfer or low 123
tubal ovum transfer, provided each such fertilization or transfer shall be 124
credited toward such maximum as one cycle; 125
(5) Limit coverage for in-vitro fertilization, gamete intra-fallopian 126
transfer, zygote intra-fallopian transfer and low tubal ovum transfer to 127
those individuals who have been unable to conceive or produce 128
conception or sustain a successful pregnancy through less expensive 129
and medically viable infertility treatment or procedures covered under 130
such policy. Nothing in this subdivision shall be construed to deny the 131
coverage required by this section to any individual who foregoes a 132
particular infertility treatment or procedure if the individual's physician 133
determines that such treatment or procedure is likely to be unsuccessful; 134
(6) Require that covered infertility treatment or procedures be 135
performed at facilities that conform to the standards and guidelines 136
developed by the American Society of Reproductive Medicine or the 137 Raised Bill No. 5446
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Society of Reproductive Endocrinology and Infertility; 138
(7) Limit coverage to individuals who have maintained coverage 139
under such policy for at least twelve months; and 140
(8) Require disclosure by the individual seeking such coverage to 141
such individual's existing health insurance carrier of any previous 142
infertility treatment or procedures for which such individual received 143
coverage under a different health insurance policy. Such disclosure shall 144
be made on a form and in the manner prescribed by the Insurance 145
Commissioner. 146
(c) (1) Any insurance company, hospital service corporation, medical 147
service corporation or health care center may issue to a religious 148
employer a group health insurance policy that excludes coverage for 149
methods of diagnosis and treatment of infertility that are contrary to the 150
religious employer's bona fide religious tenets. 151
(2) Upon the written request of an individual who states in writing 152
that methods of diagnosis and treatment of infertility are contrary to 153
such individual's religious or moral beliefs, any insurance company, 154
hospital service corporation, medical service corporation or health care 155
center may issue to or on behalf of the individual a policy or rider 156
thereto that excludes coverage for such methods. 157
(d) Any health insurance policy issued pursuant to subsection (c) of 158
this section shall provide written notice to each insured or prospective 159
insured that methods of diagnosis and treatment of infertility are 160
excluded from coverage pursuant to said subsection. Such notice shall 161
appear, in not less than ten-point type, in the policy, application and 162
sales brochure for such policy. 163
(e) As used in this section, "religious employer" means an employer 164
that is a "qualified church-controlled organization", as defined in 26 USC 165
3121 or a church-affiliated organization. 166
(f) No group health insurance policy providing coverage of the type 167 Raised Bill No. 5446
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specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 168
delivered, issued for delivery, amended, renewed or continued in this 169
state on or after January 1, 2023, shall discriminate based on an insured's 170
expected length of life, present or predicted disability, degree of medical 171
dependency, perceived quality of life, or other health conditions, or on 172
personal characteristics, including age, race, color, religious creed, 173
national origin, sex, sexual orientation, marital status or gender identity. 174
This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2023 38a-509
Sec. 2 January 1, 2023 38a-536
Statement of Purpose:
To provide equal coverage for medically necessary infertility
treatments.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]