| 12 | 13 | | A BILL TO BE ENTITLED 1 |
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| 13 | 14 | | AN ACT TO INCREASE ACCESS TO FERTILITY MEDICATION UNDER CERTAIN 2 |
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| 14 | 15 | | HEALTH BENEFIT PLANS THAT OFFER FERTILITY TREATMENT COVERAGE 3 |
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| 15 | 16 | | AND UNDER THE STATE HEALTH PLAN FOR TEACHERS AND STATE 4 |
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| 16 | 17 | | EMPLOYEES. 5 |
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| 17 | 18 | | The General Assembly of North Carolina enacts: 6 |
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| 18 | 19 | | SECTION 1.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding 7 |
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| 19 | 20 | | a new section to read: 8 |
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| 20 | 21 | | "§ 58-3-241. Fertility treatment coverage. 9 |
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| 21 | 22 | | (a) The following definitions apply in this section: 10 |
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| 22 | 23 | | (1) Experimental fertility procedure. – A procedure for which the published 11 |
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| 23 | 24 | | medical evidence is not sufficient for the American Society of Reproductive 12 |
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| 24 | 25 | | Medicine, its successor organization, or a comparable organization to regard 13 |
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| 25 | 26 | | the procedure as an established medical practice. 14 |
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| 26 | 27 | | (2) Fertility treatment. – A procedure, healthcare product, medication, or 15 |
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| 27 | 28 | | healthcare service intended to achieve pregnancy consistent with the 16 |
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| 28 | 29 | | established medical practice and professional guidelines published by the 17 |
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| 29 | 30 | | American Society of Reproductive Medicine, its successor organization, or a 18 |
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| 30 | 31 | | comparable organization. 19 |
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| 31 | 32 | | (3) Insurer. – As defined in G.S. 58-3-167. 20 |
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| 32 | 33 | | (b) If a health benefit plan offered by an insurer provides coverage for any fertility 21 |
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| 33 | 34 | | treatment, then all of the following shall apply: 22 |
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| 34 | 35 | | (1) Any limitation on coverage for ovulation medication shall not be different 23 |
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| 35 | 36 | | than the limitations imposed on other prescription medications. 24 |
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| 36 | 37 | | (2) No annual or lifetime limitations shall apply to the coverage for ovulation 25 |
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| 37 | 38 | | medication and ovulation induction cycles for services provided by healthcare 26 |
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| 38 | 39 | | providers that participate in the provider network of the health benefit plan. 27 |
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| 39 | 40 | | (c) Nothing in this section shall be construed to require coverage for fertility treatment 28 |
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| 40 | 41 | | or experimental fertility procedures under a health benefit plan." 29 |
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| 41 | 42 | | SECTION 1.(b) This section is effective October 1, 2025, and applies to insurance 30 |
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| 42 | 43 | | contracts issued, renewed, or amended on or after that date. 31 |
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| 43 | 44 | | SECTION 2. Effective with the January 1, 2026, plan coverage year, the Board of 32 |
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| 44 | 45 | | Trustees for the North Carolina State Health Plan for Teachers and State Employees (State Health 33 |
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| 45 | 46 | | Plan) shall remove any annual or lifetime limitations on the coverage for ovulation medication 34 |
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| 48 | 53 | | limitation on coverage for ovulation medication shall not be different than the limitations 1 |
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| 49 | 54 | | imposed on other prescription medications. 2 |
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| 50 | 55 | | SECTION 3. Effective July 1, 2025, there is appropriated from the General Fund to 3 |
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| 51 | 56 | | the Department of State Treasurer the sum of three hundred thousand dollars ($300,000) in 4 |
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| 52 | 57 | | recurring funds for the 2025-2026 fiscal year and the sum of six hundred thousand dollars 5 |
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| 53 | 58 | | ($600,000) in recurring funds for the 2026-2027 fiscal year for the increased costs to the State 6 |
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| 54 | 59 | | Health Plan as a result of the implementation of Section 2 of this act. 7 |
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| 55 | 60 | | SECTION 4. Except as otherwise provided, this act is effective when it becomes 8 |
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| 56 | 61 | | law. 9 |
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