STATE OF NEW YORK ________________________________________________________________________ 6118--A 2023-2024 Regular Sessions IN SENATE March 30, 2023 ___________ Introduced by Sen. HOYLMAN-SIGAL -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recom- mitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to the definition of infertility and health insurance coverage for in-vitro fertilization The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act shall be known and may be cited as "The Equity in 2 Fertility Treatment Act". 3 § 2. Items (v) and (vii) of subparagraph (C) of paragraph 6 of 4 subsection (k) of section 3221 of the insurance law, as amended by 5 section 1 of part L of chapter 57 of the laws of 2019, are amended to 6 read as follows: 7 (v)(I) For the purposes of this paragraph, "infertility" means a 8 disease or condition characterized by the incapacity to impregnate 9 another person or to conceive, defined by (a) the failure to establish a 10 clinical pregnancy after twelve months of regular, unprotected sexual 11 intercourse or therapeutic donor insemination, or after six months of 12 regular, unprotected sexual intercourse or therapeutic donor insemina- 13 tion for a female thirty-five years of age or older; (b) a person's 14 inability to reproduce either as a single individual or with their part- 15 ner without medical intervention; or (c) a licensed physician's or 16 osteopathic physician's findings based on a patient's medical, sexual, 17 or reproductive history, age, physical findings, or diagnostic testing. 18 Earlier evaluation and treatment may be warranted based on an individ- 19 ual's medical, sexual, or reproductive history [or], age, physical find- 20 ings, or diagnostic testing. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10106-04-3
S. 6118--A 2 1 (II) For purposes of this paragraph, "iatrogenic infertility" means an 2 impairment of fertility by surgery, radiation, chemotherapy or other 3 medical treatment affecting reproductive organs or processes. 4 (vii) Every large group policy delivered or issued for delivery in 5 this state that provides medical, major medical or similar comprehen- 6 sive-type coverage shall provide coverage for three [cycles of] 7 completed oocyte retrievals and in-vitro fertilization [used in the 8 treatment of infertility] with unlimited embryo transfers from fresh or 9 frozen oocytes or embryos from a covered retrieval, in accordance with 10 the guidelines of the American Society for Reproductive Medicine, using 11 single embryo transfer (SET) when recommended and medically appropriate 12 for the treatment of infertility. Coverage (I) shall not be denied based 13 on a covered individual's participation in fertility services provided 14 by or to a third party, and (II) may be subject to annual deductibles 15 and coinsurance, including copayments, as may be deemed appropriate by 16 the superintendent and as are consistent with those established for 17 other benefits within a given policy. [For purposes of this item, a 18 "cycle" is defined as either all treatment that starts when: preparatory 19 medications are administered for ovarian stimulation for oocyte 20 retrieval with the intent of undergoing in-vitro fertilization using a 21 fresh embryo transfer; or medications are administered for endometrial 22 preparation with the intent of undergoing in-vitro fertilization using a 23 frozen embryo transfer.] 24 § 3. Subparagraphs (E) and (G) of paragraph 3 of subsection (s) of 25 section 4303 of the insurance law, as amended by section 2 of part L of 26 chapter 57 of the laws of 2019, are amended to read as follows: 27 (E)(i) For the purposes of this subsection, "infertility" means a 28 disease or condition characterized by the incapacity to impregnate 29 another person or to conceive, defined by (a) the failure to establish a 30 clinical pregnancy after twelve months of regular, unprotected sexual 31 intercourse or therapeutic donor insemination, or after six months of 32 regular, unprotected sexual intercourse or therapeutic donor insemina- 33 tion for a female thirty-five years of age or older; (b) a person's 34 inability to reproduce either as a single individual or with their part- 35 ner without medical intervention; or (c) a licensed physician's or 36 osteopathic physician's findings based on a patient's medical, sexual, 37 or reproductive history, age, physical findings, or diagnostic testing. 38 Earlier evaluation and treatment may be warranted based on an individ- 39 ual's medical history or physical findings. 40 (ii) For purposes of this subsection, "iatrogenic infertility" means 41 an impairment of fertility by surgery, radiation, chemotherapy or other 42 medical treatment affecting reproductive organs or processes. 43 (G) Every large group contract that provides medical, major medical or 44 similar comprehensive-type coverage shall provide coverage for three 45 [cycles of] completed oocyte retrievals and in-vitro fertilization [used 46 in the treatment of infertility] with unlimited embryo transfers from 47 fresh or frozen oocytes or embryos from a covered retrieval, in accord- 48 ance with the guidelines of the American Society for Reproductive Medi- 49 cine, using single embryo transfer (SET) when recommended and medically 50 appropriate for the treatment of infertility. Coverage (i) shall not be 51 denied based on a covered individual's participation in fertility 52 services provided by or to a third party, and (ii) may be subject to 53 annual deductibles and coinsurance, including copayments, as may be 54 deemed appropriate by the superintendent and as are consistent with 55 those established for other benefits within a given contract. [For 56 purposes of this subparagraph, a "cycle" is defined as either all treat-
S. 6118--A 3 1 ment that starts when: preparatory medications are administered for 2 ovarian stimulation for oocyte retrieval with the intent of undergoing 3 in-vitro fertilization using a fresh embryo transfer; or medications are 4 administered for endometrial preparation with the intent of undergoing 5 in-vitro fertilization using a frozen embryo transfer.] 6 § 4. This act shall take effect immediately.