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SENATE DOCKET, NO. 1396 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 689
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Cynthia Stone Creem
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act improving access to infertility treatment.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Cynthia Stone CreemNorfolk and MiddlesexJason M. LewisFifth Middlesex2/12/2025 1 of 11
SENATE DOCKET, NO. 1396 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 689
By Ms. Creem, a petition (accompanied by bill, Senate, No. 689) of Cynthia Stone Creem and
Jason M. Lewis for legislation to improve access to infertility treatment. Financial Services.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act improving access to infertility treatment.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 47H of chapter 175, as appearing in the 2022 Official Edition, is
2hereby amended by striking out the final two sentences and inserting in place thereof the
3following:-
4 For purposes of this section, “infertility” means a condition or status characterized by any
5of the following:
6 (1) A licensed physician’s findings, based on: a patient’s medical, sexual, and
7reproductive history; age; physical findings; diagnostic testing; or any combination of those
8factors. This definition shall not prevent testing and diagnosis of infertility to establish infertility
9with or without appropriate exposure to gametes, per the patient’s provider.
10 (2) The need for medical intervention, including, but not limited to, the use of donor
11gametes, donor embryos, gestational carrier to achieve a live birth either as an individual or with
12a partner. 2 of 11
13 (3) The failure to establish a pregnancy or to carry a pregnancy to live birth after
14unprotected sexual intercourse. For purposes of this section, “unprotected sexual intercourse”
15means no more than 12 months of unprotected sexual intercourse for a person under 35 years of
16age or no more than 6 months of unprotected sexual intercourse for a person 35 years of age or
17older. Pregnancy that does not result in a live birth will not restart the 12-month or 6-month time
18period to qualify as having infertility.
19 (4) An impairment of reproductive ability due to factors, including, but not limited to,
20medical condition, male factor, female factor, combined or unexplained reproductive challenges,
21as well as genetic disorders or iatrogenic infertility.
22 Coverage for medically necessary expenses of diagnosis and treatment of infertility shall
23include, but shall not be limited to: (i) a minimum of six oocyte retrievals and unlimited fresh
24and frozen embryo transfers, using single embryo transfer when recommended by patient’s
25physician and medically appropriate; (ii) embryo transfer; (iii) artificial insemination; (iv)
26surgical sperm extraction procedures; (v) third-party reproduction including in vitro fertilization
27with donor egg, sperm, or embryo or gestational carrier; (vi) procedures necessary to screen or
28diagnose a fertilized egg before transfer, including, but not limited to, preimplantation genetic
29testing for aneuploidy, preimplantation genetic testing for chromosome structural
30rearrangements, and preimplantation genetic testing for monogenic or single gene disorders.
31 In administering coverage for medically necessary expenses of diagnosis and treatment of
32infertility, a carrier or participating provider, as those terms are defined in section 1 of chapter
33176O, shall not:
34 (1) impose conditions for eligibility beyond what is provided in the law; 3 of 11
35 (2) exclude, limit, or otherwise restrict coverage or processing of benefits for fertility
36medications that are different from those imposed on other prescription medications;
37 (3) exclude or deny coverage of any fertility services, including medication, based on an
38individual’s participation in fertility services provided by or to any third party. For purposes of
39this paragraph, “third party” includes: (i) any fresh or cryopreserved oocyte, sperm, or embryo,
40regardless of the initial coverage source of the donor or the genetic material; and (ii) a gestational
41carrier that enables an intended parent, member, and/or partner of a member to become a parent.
42 (4) exclude services based on the quantity of the patient’s existing cryopreserved oocyte,
43sperm, or embryos; the provider’s discretion will determine if cryopreserved oocyte, sperm, or
44embryo provides a reasonable chance of success and whether additional fertility services are
45required;
46 (5) implement any deductible, copayment, coinsurance, benefit maximum, waiting
47period, or other limitation on coverage that is different from those imposed upon benefits for
48services not related to infertility;
49 (6) impose limitations on coverage based solely on arbitrary, non-medically based factors
50including, but not limited to, number of attempts, dollar amounts, or age; or
51 (7) provide different benefits to, or impose different requirements for different groups,
52based on diagnosis.
53 Limitations on coverage coverage for medically necessary expenses of diagnosis and
54treatment of infertility shall be based on clinical guidelines and the patient's medical history.
55Clinical guidelines shall be maintained in written form and available to any enrollee. Standards 4 of 11
56or guidelines developed by the American Society for Reproductive Medicine, the American
57College of Obstetrics and Gynecology, the Society for Assisted Reproductive Technology, or
58similar relevant medical societies may serve as a basis for such clinical guidelines. Making,
59issuing, circulating, or causing to be made, issued or circulated, any clinical guidelines that are
60based upon data that are not reasonably current or that do not cite with specificity any references
61relied upon shall constitute an unfair and deceptive act and practice pursuant to section 2 of
62chapter 93A.
63 Consistent with Massachusetts anti-discrimination law, coverage for medically necessary
64expenses of diagnosis and treatment of infertility shall be provided without discrimination based
65on age, ancestry, color, disability, domestic partner status, gender, gender expression, gender
66identity, genetic information, marital status, national origin, race, religion, sex, or sexual
67orientation.
68 This section shall not be construed to deny or restrict any existing right or benefit to
69coverage and treatment of infertility or fertility services under an existing law, plan, or policy.
70This section shall not be construed to interfere with a medical provider’s, physician’s, or
71surgeon’s clinical judgment.
72 SECTION 2. Section 8K of chapter 176A, as appearing in the 2022 Official Edition, is
73hereby amended by striking out the final two sentences and inserting in place thereof the
74following:-
75 For purposes of this section, “infertility” means a condition or status characterized by any
76of the following: 5 of 11
77 (1) A licensed physician’s findings, based on: a patient’s medical, sexual, and
78reproductive history; age; physical findings; diagnostic testing; or any combination of those
79factors. This definition shall not prevent testing and diagnosis of infertility to establish infertility
80with or without appropriate exposure to gametes, per the patient’s provider.
81 (2) The need for medical intervention, including, but not limited to, the use of donor
82gametes, donor embryos, gestational carrier to achieve a live birth either as an individual or with
83a partner.
84 (3) The failure to establish a pregnancy or to carry a pregnancy to live birth after
85unprotected sexual intercourse. For purposes of this section, “unprotected sexual intercourse”
86means no more than 12 months of unprotected sexual intercourse for a person under 35 years of
87age or no more than 6 months of unprotected sexual intercourse for a person 35 years of age or
88older. Pregnancy that does not result in a live birth will not restart the 12-month or 6-month time
89period to qualify as having infertility.
90 (4) An impairment of reproductive ability due to factors, including, but not limited to,
91medical condition, male factor, female factor, combined or unexplained reproductive challenges,
92as well as genetic disorders or iatrogenic infertility.
93 Coverage for medically necessary expenses of diagnosis and treatment of infertility shall
94include, but shall not be limited to: (i) a minimum of six oocyte retrievals and unlimited fresh
95and frozen embryo transfers, using single embryo transfer when recommended by patient’s
96physician and medically appropriate; (ii) embryo transfer; (iii) artificial insemination; (iv)
97surgical sperm extraction procedures; (v) third-party reproduction including in vitro fertilization
98with donor egg, sperm, or embryo or gestational carrier; (vi) procedures necessary to screen or 6 of 11
99diagnose a fertilized egg before transfer, including, but not limited to, preimplantation genetic
100testing for aneuploidy, preimplantation genetic testing for chromosome structural
101rearrangements, and preimplantation genetic testing for monogenic or single gene disorders.
102 In administering coverage for medically necessary expenses of diagnosis and treatment of
103infertility, a carrier or participating provider, as those terms are defined in section 1 of chapter
104176O, shall not:
105 (1) impose conditions for eligibility beyond what is provided in the law;
106 (2) exclude, limit, or otherwise restrict coverage or processing of benefits for fertility
107medications that are different from those imposed on other prescription medications;
108 (3) exclude or deny coverage of any fertility services, including medication, based on an
109individual’s participation in fertility services provided by or to any third party. For purposes of
110this paragraph, “third party” includes: (i) any fresh or cryopreserved oocyte, sperm, or embryo,
111regardless of the initial coverage source of the donor or the genetic material; and (ii) a gestational
112carrier that enables an intended parent, member, and/or partner of a member to become a parent.
113 (4) exclude services based on the quantity of the patient’s existing cryopreserved oocyte,
114sperm, or embryos; the provider’s discretion will determine if cryopreserved oocyte, sperm, or
115embryo provides a reasonable chance of success and whether additional fertility services are
116required;
117 (5) implement any deductible, copayment, coinsurance, benefit maximum, waiting
118period, or other limitation on coverage that is different from those imposed upon benefits for
119services not related to infertility; 7 of 11
120 (6) impose limitations on coverage based solely on arbitrary, non-medically based factors
121including, but not limited to, number of attempts, dollar amounts, or age; or
122 (7) provide different benefits to, or impose different requirements for different groups,
123based on diagnosis.
124 Limitations on coverage coverage for medically necessary expenses of diagnosis and
125treatment of infertility shall be based on clinical guidelines and the patient's medical history.
126Clinical guidelines shall be maintained in written form and available to any enrollee. Standards
127or guidelines developed by the American Society for Reproductive Medicine, the American
128College of Obstetrics and Gynecology, the Society for Assisted Reproductive Technology, or
129similar relevant medical societies may serve as a basis for such clinical guidelines. Making,
130issuing, circulating, or causing to be made, issued or circulated, any clinical guidelines that are
131based upon data that are not reasonably current or that do not cite with specificity any references
132relied upon shall constitute an unfair and deceptive act and practice pursuant to section 2 of
133chapter 93A.
134 Consistent with Massachusetts anti-discrimination law, coverage for medically necessary
135expenses of diagnosis and treatment of infertility shall be provided without discrimination based
136on age, ancestry, color, disability, domestic partner status, gender, gender expression, gender
137identity, genetic information, marital status, national origin, race, religion, sex, or sexual
138orientation.
139 This section shall not be construed to deny or restrict any existing right or benefit to
140coverage and treatment of infertility or fertility services under an existing law, plan, or policy. 8 of 11
141This section shall not be construed to interfere with a medical provider’s, physician’s, or
142surgeon’s clinical judgment.
143 SECTION 3. Section 4J of chapter 176B, as appearing in the 2022 Official Edition, is
144hereby amended by striking out the final two sentences and inserting in place thereof the
145following:-
146 For purposes of this section, “infertility” means a condition or status characterized by any
147of the following:
148 (1) A licensed physician’s findings, based on: a patient’s medical, sexual, and
149reproductive history; age; physical findings; diagnostic testing; or any combination of those
150factors. This definition shall not prevent testing and diagnosis of infertility to establish infertility
151with or without appropriate exposure to gametes, per the patient’s provider.
152 (2) The need for medical intervention, including, but not limited to, the use of donor
153gametes, donor embryos, gestational carrier to achieve a live birth either as an individual or with
154a partner.
155 (3) The failure to establish a pregnancy or to carry a pregnancy to live birth after
156unprotected sexual intercourse. For purposes of this section, “unprotected sexual intercourse”
157means no more than 12 months of unprotected sexual intercourse for a person under 35 years of
158age or no more than 6 months of unprotected sexual intercourse for a person 35 years of age or
159older. Pregnancy that does not result in a live birth will not restart the 12-month or 6-month time
160period to qualify as having infertility. 9 of 11
161 (4) An impairment of reproductive ability due to factors, including, but not limited to,
162medical condition, male factor, female factor, combined or unexplained reproductive challenges,
163as well as genetic disorders or iatrogenic infertility.
164 Coverage for medically necessary expenses of diagnosis and treatment of infertility shall
165include, but shall not be limited to: (i) a minimum of six oocyte retrievals and unlimited fresh
166and frozen embryo transfers, using single embryo transfer when recommended by patient’s
167physician and medically appropriate; (ii) embryo transfer; (iii) artificial insemination; (iv)
168surgical sperm extraction procedures; (v) third-party reproduction including in vitro fertilization
169with donor egg, sperm, or embryo or gestational carrier; (vi) procedures necessary to screen or
170diagnose a fertilized egg before transfer, including, but not limited to, preimplantation genetic
171testing for aneuploidy, preimplantation genetic testing for chromosome structural
172rearrangements, and preimplantation genetic testing for monogenic or single gene disorders.
173 In administering coverage for medically necessary expenses of diagnosis and treatment of
174infertility, a carrier or participating provider, as those terms are defined in section 1 of chapter
175176O, shall not:
176 (1) impose conditions for eligibility beyond what is provided in the law;
177 (2) exclude, limit, or otherwise restrict coverage or processing of benefits for fertility
178medications that are different from those imposed on other prescription medications;
179 (3) exclude or deny coverage of any fertility services, including medication, based on an
180individual’s participation in fertility services provided by or to any third party. For purposes of
181this paragraph, “third party” includes: (i) any fresh or cryopreserved oocyte, sperm, or embryo, 10 of 11
182regardless of the initial coverage source of the donor or the genetic material; and (ii) a gestational
183carrier that enables an intended parent, member, and/or partner of a member to become a parent.
184 (4) exclude services based on the quantity of the patient’s existing cryopreserved oocyte,
185sperm, or embryos; the provider’s discretion will determine if cryopreserved oocyte, sperm, or
186embryo provides a reasonable chance of success and whether additional fertility services are
187required;
188 (5) implement any deductible, copayment, coinsurance, benefit maximum, waiting
189period, or other limitation on coverage that is different from those imposed upon benefits for
190services not related to infertility;
191 (6) impose limitations on coverage based solely on arbitrary, non-medically based factors
192including, but not limited to, number of attempts, dollar amounts, or age; or
193 (7) provide different benefits to, or impose different requirements for different groups,
194based on diagnosis.
195 Limitations on coverage coverage for medically necessary expenses of diagnosis and
196treatment of infertility shall be based on clinical guidelines and the patient's medical history.
197Clinical guidelines shall be maintained in written form and available to any enrollee. Standards
198or guidelines developed by the American Society for Reproductive Medicine, the American
199College of Obstetrics and Gynecology, the Society for Assisted Reproductive Technology, or
200similar relevant medical societies may serve as a basis for such clinical guidelines. Making,
201issuing, circulating, or causing to be made, issued or circulated, any clinical guidelines that are
202based upon data that are not reasonably current or that do not cite with specificity any references 11 of 11
203relied upon shall constitute an unfair and deceptive act and practice pursuant to section 2 of
204chapter 93A.
205 Consistent with Massachusetts anti-discrimination law, coverage for medically necessary
206expenses of diagnosis and treatment of infertility shall be provided without discrimination based
207on age, ancestry, color, disability, domestic partner status, gender, gender expression, gender
208identity, genetic information, marital status, national origin, race, religion, sex, or sexual
209orientation.
210 This section shall not be construed to deny or restrict any existing right or benefit to
211coverage and treatment of infertility or fertility services under an existing law, plan, or policy.
212This section shall not be construed to interfere with a medical provider’s, physician’s, or
213surgeon’s clinical judgment.