NJ
New Jersey Senate Bill S2542

New Jersey 2022-2023 Regular Session

New Jersey Senate Bill S2542 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 SENATE, No. 2542 STATE OF NEW JERSEY 220th LEGISLATURE INTRODUCED MAY 12, 2022
22
33 SENATE, No. 2542
44
55
66
77 STATE OF NEW JERSEY
88
99 220th LEGISLATURE
1010
1111
1212
1313 INTRODUCED MAY 12, 2022
1414
1515
1616
1717 Sponsored by: Senator TROY SINGLETON District 7 (Burlington) SYNOPSIS Requires health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions. CURRENT VERSION OF TEXT As introduced.
1818
1919
2020
2121 Sponsored by:
2222
2323 Senator TROY SINGLETON
2424
2525 District 7 (Burlington)
2626
2727
2828
2929
3030
3131
3232
3333
3434
3535 SYNOPSIS
3636
3737 Requires health insurance coverage of preimplantation genetic testing with in vitro fertilization under certain conditions.
3838
3939
4040
4141 CURRENT VERSION OF TEXT
4242
4343 As introduced.
4444
4545
4646
4747 An Act concerning health insurance coverage of preimplantation genetic testing and in vitro fertilization and amending various parts of the statutory law. Be It Enacted by the Senate and General Assembly of the State of New Jersey: 1. Section 1 of P.L.2001, c.236 (C.17:48-6x) is amended to read as follows: 1. a. A hospital service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The hospital service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The hospital service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The hospital service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. [b] d. A religious employer may request, and a hospital service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The hospital service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than 10 point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3). [c] e. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium. [d] f. The provisions of this section shall not apply to a hospital service corporation contract which, pursuant to a contract between the hospital service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services. (cf: P.L.2017, c.48, s.1) 2. Section 2 of P.L.2001, c.236 (C.17:48A-7w) is amended to read as follows: 2. a. A medical service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The medical service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The medical service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The medical service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. [b] d. A religious employer may request, and a medical service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The medical service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3). [c] e. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium. [d] f. The provisions of this section shall not apply to a medical service corporation contract which, pursuant to a contract between the medical service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services. (cf: P.L.2017, c.48, s.2) 3. Section 3 of P.L.2001, c.236 (C.17:48E-35.22) is amended to read as follows: 3. a. A health service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The health service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The health service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The health service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. [b] d. A religious employer may request, and a health service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The health service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3). [c] e. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium. [d] f. The provisions of this section shall not apply to a health service corporation contract which, pursuant to a contract between the health service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services. (cf: P.L.2017, c.48, s.3) 4. Section 4 of P.L.2001, c.236 (C.17B:27-46.1x) is amended to read as follows: 4. a. A group health insurance policy which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the policy provides coverage for persons covered under the policy for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The policy shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The insurer may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The insurer may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the policy, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the policy. Infertility resulting from voluntary sterilization procedures shall be excluded under the policy for the coverage required by this section. [b] d. A religious employer may request, and an insurer shall grant, an exclusion under the policy for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The insurer that issues a policy containing such an exclusion shall provide written notice thereof to each prospective insured or insured, which shall appear in not less than ten point type, in the policy, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3). [c] e. This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium. [d] f. The provisions of this section shall not apply to a group health insurance policy which, pursuant to a contract between the insurer and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services. (cf: P.L.2017, c.48, s.4) 5. Section 5 of P.L.2001, c.236 (C.26:2J-4.23) is amended to read as follows: 5. a. No certificate of authority to establish and operate a health maintenance organization in this State shall be issued or continued on or after the effective date of this act unless the health maintenance organization provides health care services, to groups of more than 50 enrollees, for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. A health maintenance organization shall provide enrollee coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the enrollee. The health maintenance organization may provide that health care services for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The health maintenance organization may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The health care services shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical health care services under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. [b] d. A religious employer may request, and a health maintenance organization shall grant, an exclusion under the contract for the health care services required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required health care services are contrary to the religious employer's bona fide religious tenets. The health maintenance organization that issues a contract containing such an exclusion shall provide written notice thereof to each prospective enrollee or enrollee, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3). [c] e. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved. [d] f. The provisions of this section shall not apply to a contract for health care services by a health maintenance organization which, pursuant to a contract between the health maintenance organization and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services. (cf: P.L.2017, c.48, s.5) 6. Section 6 of P.L.2017, c.48 (C.52:14-17.29v) is amended to read as follows: 6. a. The State Health Benefits Commission shall ensure that every contract under the State Health Benefits Program shall provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The State Health Benefits Program contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The State Health Benefits Commission may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The State Health Benefits Commission may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or any one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. (cf: P.L.2017, c.48, s.6) 7. Section 7 of P.L.2017, c.48 (C.52:14-17.46.6g) is amended to read as follows: 7. a. The School Employees Health Benefits Commission shall ensure that every contract under the School Employees Health Benefits Program shall provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The School Employees Health Benefits Program contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The School Employees Health Benefits Commission may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The School Employees Health Benefits Commission may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where: (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability. b. [For purposes of] As used in this section[,]: ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or any one of the following conditions: (1) A male is unable to impregnate a female; (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse; (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse; (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision; (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision; (6) Partners are unable to conceive as a result of involuntary medical sterility; (7) A person is unable to carry a pregnancy to live birth; or (8) A previous determination of infertility pursuant to this section. "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section. (cf: P.L.2017, c.48, s.7) 8. This act shall take effect on the 90th day next following enactment and shall apply to policies or contracts delivered, issued, or renewed on or after that date. STATEMENT This bill requires health insurance carriers to provide coverage of preimplantation genetic testing (PGT) and in vitro fertilization for covered persons who are not infertile to prevent certain serious genetic medical conditions from being passed on to offspring under certain conditions. Under the bill, health insurance carriers (which include hospital service corporations, medical service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, group health insurance policies, and any entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees' Health Benefits Program) will be required to cover PGT with in vitro fertilization even if the covered person is not infertile, where (1) both partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability For the purposes of this bill, "preimplantation genetic testing" is defined as a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
4848
4949 An Act concerning health insurance coverage of preimplantation genetic testing and in vitro fertilization and amending various parts of the statutory law.
5050
5151
5252
5353 Be It Enacted by the Senate and General Assembly of the State of New Jersey:
5454
5555
5656
5757 1. Section 1 of P.L.2001, c.236 (C.17:48-6x) is amended to read as follows:
5858
5959 1. a. A hospital service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The hospital service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The hospital service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The hospital service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
6060
6161 (1) both partners are known carriers of an autosomal recessive disorder;
6262
6363 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
6464
6565 (3) one partner is a known carrier of a single gene autosomal disorder;
6666
6767 (4) one partner is a known carrier of a single X-linked disorder; and
6868
6969 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
7070
7171 b. [For purposes of] As used in this section[,]:
7272
7373 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions:
7474
7575 (1) A male is unable to impregnate a female;
7676
7777 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
7878
7979 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
8080
8181 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
8282
8383 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
8484
8585 (6) Partners are unable to conceive as a result of involuntary medical sterility;
8686
8787 (7) A person is unable to carry a pregnancy to live birth; or
8888
8989 (8) A previous determination of infertility pursuant to this section.
9090
9191 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
9292
9393 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
9494
9595 [b] d. A religious employer may request, and a hospital service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The hospital service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than 10 point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
9696
9797 [c] e. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
9898
9999 [d] f. The provisions of this section shall not apply to a hospital service corporation contract which, pursuant to a contract between the hospital service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services.
100100
101101 (cf: P.L.2017, c.48, s.1)
102102
103103
104104
105105 2. Section 2 of P.L.2001, c.236 (C.17:48A-7w) is amended to read as follows:
106106
107107 2. a. A medical service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The medical service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The medical service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The medical service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
108108
109109 (1) both partners are known carriers of an autosomal recessive disorder;
110110
111111 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
112112
113113 (3) one partner is a known carrier of a single gene autosomal disorder;
114114
115115 (4) one partner is a known carrier of a single X-linked disorder; and
116116
117117 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
118118
119119 b. [For purposes of] As used in this section[,]:
120120
121121 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions:
122122
123123 (1) A male is unable to impregnate a female;
124124
125125 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
126126
127127 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
128128
129129 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
130130
131131 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
132132
133133 (6) Partners are unable to conceive as a result of involuntary medical sterility;
134134
135135 (7) A person is unable to carry a pregnancy to live birth; or
136136
137137 (8) A previous determination of infertility pursuant to this section.
138138
139139 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
140140
141141 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
142142
143143 [b] d. A religious employer may request, and a medical service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The medical service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
144144
145145 [c] e. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
146146
147147 [d] f. The provisions of this section shall not apply to a medical service corporation contract which, pursuant to a contract between the medical service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services.
148148
149149 (cf: P.L.2017, c.48, s.2)
150150
151151
152152
153153 3. Section 3 of P.L.2001, c.236 (C.17:48E-35.22) is amended to read as follows:
154154
155155 3. a. A health service corporation contract which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the contract provides coverage for persons covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The health service corporation contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The health service corporation may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The health service corporation may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
156156
157157 (1) both partners are known carriers of an autosomal recessive disorder;
158158
159159 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
160160
161161 (3) one partner is a known carrier of a single gene autosomal disorder;
162162
163163 (4) one partner is a known carrier of a single X-linked disorder; and
164164
165165 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
166166
167167 b. [For purposes of] As used in this section[,]:
168168
169169 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions:
170170
171171 (1) A male is unable to impregnate a female;
172172
173173 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
174174
175175 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
176176
177177 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
178178
179179 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
180180
181181 (6) Partners are unable to conceive as a result of involuntary medical sterility;
182182
183183 (7) A person is unable to carry a pregnancy to live birth; or
184184
185185 (8) A previous determination of infertility pursuant to this section.
186186
187187 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
188188
189189 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
190190
191191 [b] d. A religious employer may request, and a health service corporation shall grant, an exclusion under the contract for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The health service corporation that issues a contract containing such an exclusion shall provide written notice thereof to each prospective subscriber or subscriber, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
192192
193193 [c] e. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
194194
195195 [d] f. The provisions of this section shall not apply to a health service corporation contract which, pursuant to a contract between the health service corporation and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services.
196196
197197 (cf: P.L.2017, c.48, s.3)
198198
199199
200200
201201 4. Section 4 of P.L.2001, c.236 (C.17B:27-46.1x) is amended to read as follows:
202202
203203 4. a. A group health insurance policy which provides hospital or medical expense benefits for groups with more than 50 persons, which includes pregnancy-related benefits, shall not be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act unless the policy provides coverage for persons covered under the policy for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The policy shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The insurer may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The insurer may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
204204
205205 (1) both partners are known carriers of an autosomal recessive disorder;
206206
207207 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
208208
209209 (3) one partner is a known carrier of a single gene autosomal disorder;
210210
211211 (4) one partner is a known carrier of a single X-linked disorder; and
212212
213213 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
214214
215215 b. [For purposes of] As used in this section[,]:
216216
217217 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions:
218218
219219 (1) A male is unable to impregnate a female;
220220
221221 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
222222
223223 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
224224
225225 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
226226
227227 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
228228
229229 (6) Partners are unable to conceive as a result of involuntary medical sterility;
230230
231231 (7) A person is unable to carry a pregnancy to live birth; or
232232
233233 (8) A previous determination of infertility pursuant to this section.
234234
235235 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
236236
237237 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the policy, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the policy. Infertility resulting from voluntary sterilization procedures shall be excluded under the policy for the coverage required by this section.
238238
239239 [b] d. A religious employer may request, and an insurer shall grant, an exclusion under the policy for the coverage required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required coverage is contrary to the religious employer's bona fide religious tenets. The insurer that issues a policy containing such an exclusion shall provide written notice thereof to each prospective insured or insured, which shall appear in not less than ten point type, in the policy, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
240240
241241 [c] e. This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium.
242242
243243 [d] f. The provisions of this section shall not apply to a group health insurance policy which, pursuant to a contract between the insurer and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services.
244244
245245 (cf: P.L.2017, c.48, s.4)
246246
247247
248248
249249 5. Section 5 of P.L.2001, c.236 (C.26:2J-4.23) is amended to read as follows:
250250
251251 5. a. No certificate of authority to establish and operate a health maintenance organization in this State shall be issued or continued on or after the effective date of this act unless the health maintenance organization provides health care services, to groups of more than 50 enrollees, for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. A health maintenance organization shall provide enrollee coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the enrollee. The health maintenance organization may provide that health care services for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The health maintenance organization may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
252252
253253 (1) both partners are known carriers of an autosomal recessive disorder;
254254
255255 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
256256
257257 (3) one partner is a known carrier of a single gene autosomal disorder;
258258
259259 (4) one partner is a known carrier of a single X-linked disorder; and
260260
261261 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
262262
263263 b. [For purposes of] As used in this section[,]:
264264
265265 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or that the patient has met one of the following conditions:
266266
267267 (1) A male is unable to impregnate a female;
268268
269269 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
270270
271271 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
272272
273273 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
274274
275275 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
276276
277277 (6) Partners are unable to conceive as a result of involuntary medical sterility;
278278
279279 (7) A person is unable to carry a pregnancy to live birth; or
280280
281281 (8) A previous determination of infertility pursuant to this section.
282282
283283 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
284284
285285 c. The health care services shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical health care services under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
286286
287287 [b] d. A religious employer may request, and a health maintenance organization shall grant, an exclusion under the contract for the health care services required by this section for in vitro fertilization, embryo transfer, artificial insemination, zygote intra fallopian transfer and intracytoplasmic sperm injection, if the required health care services are contrary to the religious employer's bona fide religious tenets. The health maintenance organization that issues a contract containing such an exclusion shall provide written notice thereof to each prospective enrollee or enrollee, which shall appear in not less than ten point type, in the contract, application and sales brochure. For the purposes of this subsection, "religious employer" means an employer that is a church, convention or association of churches or any group or entity that is operated, supervised or controlled by or in connection with a church or a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
288288
289289 [c] e. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
290290
291291 [d] f. The provisions of this section shall not apply to a contract for health care services by a health maintenance organization which, pursuant to a contract between the health maintenance organization and the Department of Human Services, provides benefits to persons who are eligible for medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the Division of Medical Assistance and Health Services in the Department of Human Services.
292292
293293 (cf: P.L.2017, c.48, s.5)
294294
295295 6. Section 6 of P.L.2017, c.48 (C.52:14-17.29v) is amended to read as follows:
296296
297297 6. a. The State Health Benefits Commission shall ensure that every contract under the State Health Benefits Program shall provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The State Health Benefits Program contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The State Health Benefits Commission may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The State Health Benefits Commission may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
298298
299299 (1) both partners are known carriers of an autosomal recessive disorder;
300300
301301 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
302302
303303 (3) one partner is a known carrier of a single gene autosomal disorder;
304304
305305 (4) one partner is a known carrier of a single X-linked disorder; and
306306
307307 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
308308
309309 b. [For purposes of] As used in this section[,]:
310310
311311 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or any one of the following conditions:
312312
313313 (1) A male is unable to impregnate a female;
314314
315315 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
316316
317317 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
318318
319319 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
320320
321321 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
322322
323323 (6) Partners are unable to conceive as a result of involuntary medical sterility;
324324
325325 (7) A person is unable to carry a pregnancy to live birth; or
326326
327327 (8) A previous determination of infertility pursuant to this section.
328328
329329 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
330330
331331 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
332332
333333 (cf: P.L.2017, c.48, s.6)
334334
335335
336336
337337 7. Section 7 of P.L.2017, c.48 (C.52:14-17.46.6g) is amended to read as follows:
338338
339339 7. a. The School Employees Health Benefits Commission shall ensure that every contract under the School Employees Health Benefits Program shall provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, as provided pursuant to this section, and for preimplantation genetic testing, including in vitro fertilization, where the covered persons are not infertile, for the purpose of preventing certain serious genetic conditions from being passed on to offspring. The School Employees Health Benefits Program contract shall provide coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The School Employees Health Benefits Commission may provide that coverage for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger. The School Employees Health Benefits Commission may also provide that coverage for preimplantation genetic testing with in vitro fertilization be limited to covered persons where:
340340
341341 (1) both partners are known carriers of an autosomal recessive disorder;
342342
343343 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
344344
345345 (3) one partner is a known carrier of a single gene autosomal disorder;
346346
347347 (4) one partner is a known carrier of a single X-linked disorder; and
348348
349349 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability.
350350
351351 b. [For purposes of] As used in this section[,]:
352352
353353 ["infertility"] "Infertility" means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or any one of the following conditions:
354354
355355 (1) A male is unable to impregnate a female;
356356
357357 (2) A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
358358
359359 (3) A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
360360
361361 (4) A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
362362
363363 (5) A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
364364
365365 (6) Partners are unable to conceive as a result of involuntary medical sterility;
366366
367367 (7) A person is unable to carry a pregnancy to live birth; or
368368
369369 (8) A previous determination of infertility pursuant to this section.
370370
371371 "Preimplantation genetic testing" means a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.
372372
373373 c. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided for in this section shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits shall apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. Infertility resulting from voluntary sterilization procedures shall be excluded under the contract for the coverage required by this section.
374374
375375 (cf: P.L.2017, c.48, s.7)
376376
377377
378378
379379 8. This act shall take effect on the 90th day next following enactment and shall apply to policies or contracts delivered, issued, or renewed on or after that date.
380380
381381
382382
383383
384384
385385 STATEMENT
386386
387387
388388
389389 This bill requires health insurance carriers to provide coverage of preimplantation genetic testing (PGT) and in vitro fertilization for covered persons who are not infertile to prevent certain serious genetic medical conditions from being passed on to offspring under certain conditions.
390390
391391 Under the bill, health insurance carriers (which include hospital service corporations, medical service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, group health insurance policies, and any entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees' Health Benefits Program) will be required to cover PGT with in vitro fertilization even if the covered person is not infertile, where
392392
393393 (1) both partners are known carriers of an autosomal recessive disorder;
394394
395395 (2) one partner is a known carrier of a single gene autosomal recessive disorder and the partners have one offspring that has been diagnosed with that recessive disorder;
396396
397397 (3) one partner is a known carrier of a single gene autosomal disorder;
398398
399399 (4) one partner is a known carrier of a single X-linked disorder; and
400400
401401 (5) the genetic condition, if passed on to the covered persons' offspring, would result in significant health problems or severe disability
402402
403403 For the purposes of this bill, "preimplantation genetic testing" is defined as a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy.