STATE OF NEW YORK ________________________________________________________________________ 7175 2025-2026 Regular Sessions IN ASSEMBLY March 21, 2025 ___________ Introduced by M. of A. BICHOTTE HERMELYN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to expanding insurance coverage of in vitro fertilization, including individual health insur- ance policy coverage The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Item (vii) of subparagraph (C) of paragraph 6 of subsection 2 (k) of section 3221 of the insurance law, as amended by section 1 of 3 part L of chapter 57 of the laws of 2019, is amended to read as follows: 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 in-vitro] 7 complete oocyte retrievals and in vitro fertilization used in the treat- 8 ment of infertility with unlimited embryo transfers from fresh or frozen 9 oocytes or embryos from a covered retrieval. Coverage may be subject to 10 annual deductibles and coinsurance, including copayments, as may be 11 deemed appropriate by the superintendent and as are consistent with 12 those established for other benefits within a given policy. [For 13 purposes of this item, a "cycle" is defined as either all treatment that 14 starts when: preparatory medications are administered for ovarian stimu- 15 lation for oocyte retrieval with the intent of undergoing in-vitro 16 fertilization using a fresh embryo transfer; or medications are adminis- 17 tered for endometrial preparation with the intent of undergoing in-vitro 18 fertilization using a frozen embryo transfer.] 19 § 2. Subparagraph (G) of paragraph 3 of subsection (s) of section 4303 20 of the insurance law, as amended by section 2 of part L of chapter 57 of 21 the laws of 2019, is amended to read as follows: 22 (G) Every large group contract that provides medical, major medical or 23 similar comprehensive-type coverage shall provide coverage for three 24 [cycles of in-vitro] complete oocyte retrievals and in vitro fertiliza- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05127-01-5
A. 7175 2 1 tion used in the treatment of infertility with unlimited embryo trans- 2 fers from fresh or frozen oocytes or embryos from a covered retrieval. 3 Coverage may be subject to annual deductibles and coinsurance, including 4 copayments, as may be deemed appropriate by the superintendent and as 5 are consistent with those established for other benefits within a given 6 contract. [For purposes of this subparagraph, a "cycle" is defined as 7 either all treatment that starts when: preparatory medications are 8 administered for ovarian stimulation for oocyte retrieval with the 9 intent of undergoing in-vitro fertilization using a fresh embryo trans- 10 fer; or medications are administered for endometrial preparation with 11 the intent of undergoing in-vitro fertilization using a frozen embryo 12 transfer.] 13 § 3. Paragraph 13 of subsection (i) of section 3216 of the insurance 14 law, as added by chapter 897 of the laws of 1990 and renumbered by chap- 15 ter 131 of the laws of 1992 and subparagraph (C) as added by section 3 16 of part L of chapter 57 of the laws of 2019, is amended to read as 17 follows: 18 (13) (A) Every policy which provides coverage for hospital care shall 19 not exclude coverage for hospital care for diagnosis and treatment of 20 correctable medical conditions otherwise covered by the policy solely 21 because the medical condition results in infertility[.]; provided, 22 however that: 23 (i) subject to the provisions of subparagraph (C) of this paragraph, 24 in no case shall such coverage exclude surgical or medical procedures 25 provided as part of such hospital care which would correct malformation, 26 disease or dysfunction resulting in infertility; and 27 (ii) provided, further however, that subject to the provisions of 28 subparagraph (C) of this paragraph, in no case shall such coverage 29 exclude diagnostic tests and procedures provided as part of such hospi- 30 tal care that are necessary to determine infertility or that are neces- 31 sary in connection with any surgical or medical treatments or 32 prescription drug coverage provided pursuant to this paragraph, includ- 33 ing such diagnostic tests and procedures as hysterosalpingogram, hyster- 34 oscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital 35 tests, testis biopsy, semen analysis, blood tests and ultrasound; and 36 (iii) provided, further however, every such policy which provides 37 coverage for prescription drugs shall include, within such coverage, 38 coverage for prescription drugs approved by the federal Food and Drug 39 Administration for use in the diagnosis and treatment of infertility in 40 accordance with subparagraph (C) of this paragraph. 41 (B) Every policy which provides coverage for surgical and medical care 42 shall not exclude coverage for surgical and medical care for diagnosis 43 and treatment of correctable medical conditions otherwise covered by the 44 policy solely because the medical condition results in infertility[.]; 45 provided, however that: 46 (i) subject to the provisions of subparagraph (C) of this paragraph, 47 in no case shall such coverage exclude surgical or medical procedures 48 which would correct malformation, disease or dysfunction resulting in 49 infertility; and 50 (ii) provided, further however, that subject to the provisions of 51 subparagraph (C) of this paragraph, in no case shall such coverage 52 exclude diagnostic tests and procedures that are necessary to determine 53 infertility or that are necessary in connection with any surgical or 54 medical treatments or prescription drug coverage provided pursuant to 55 this paragraph, including such diagnostic tests and procedures as 56 hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy,
A. 7175 3 1 sono-hysterogram, post coital tests, testis biopsy, semen analysis, 2 blood tests and ultrasound; and 3 (iii) provided, further however, every such policy which provides 4 coverage for prescription drugs shall include, within such coverage, 5 coverage for prescription drugs approved by the federal Food and Drug 6 Administration for use in the diagnosis and treatment of infertility in 7 accordance with subparagraph (C) of this paragraph. 8 (C) [Every policy that provides medical, major medical or similar 9 comprehensive-type coverage shall provide coverage for] Coverage of 10 diagnostic and treatment procedures, including prescription drugs, used 11 in the diagnosis and treatment of infertility as required by subpara- 12 graphs (A) and (B) of this paragraph shall be provided in accordance 13 with the provisions of this subparagraph. 14 (i) Diagnosis and treatment of infertility shall be prescribed as part 15 of a physician's overall plan of care and consistent with the guidelines 16 for coverage as referenced in this subparagraph. 17 (ii) Coverage may be subject to co-payments, coinsurance and deduct- 18 ibles as may be deemed appropriate by the superintendent and as are 19 consistent with those established for other benefits within a given 20 policy. 21 (iii) Except as provided in items (vi) and (vii) of this subparagraph, 22 coverage shall not be required to include the diagnosis and treatment of 23 infertility in connection with: (I) in vitro fertilization, gamete 24 intrafallopian tube transfers or zygote intrafallopian tube transfers; 25 (II) the reversal of elective sterilizations; (III) sex change proce- 26 dures; (IV) cloning; or (V) medical or surgical services or procedures 27 that are deemed to be experimental in accordance with clinical guide- 28 lines referenced in item (iv) of this subparagraph. 29 (iv) The superintendent, in consultation with the commissioner of 30 health, shall promulgate regulations which shall stipulate the guide- 31 lines and standards which shall be used in carrying out the provisions 32 of this subparagraph, which shall include: 33 (I) The identification of experimental procedures and treatments not 34 covered for the diagnosis and treatment of infertility determined in 35 accordance with the standards and guidelines established and adopted by 36 the American College of Obstetricians and Gynecologists and the American 37 Society for Reproductive Medicine; 38 (II) The identification of the required training, experience and other 39 standards for health care providers for the provision of procedures and 40 treatments for the diagnosis and treatment of infertility determined in 41 accordance with the standards and guidelines established and adopted by 42 the American College of Obstetricians and Gynecologists and the American 43 Society for Reproductive Medicine; and 44 (III) The determination of appropriate medical candidates by the 45 treating physician in accordance with the standards and guidelines 46 established and adopted by the American College of Obstetricians and 47 Gynecologists and/or the American Society for Reproductive Medicine. 48 (v) Coverage shall also include standard fertility preservation 49 services when a medical treatment may directly or indirectly cause 50 iatrogenic infertility to an insured. Coverage may be subject to annual 51 deductibles and coinsurance, including copayments, as may be deemed 52 appropriate by the superintendent and as are consistent with those 53 established for other benefits within a given policy. 54 [(i)] (vi) Every policy which provides coverage for hospital care 55 shall provide coverage for three complete oocyte retrievals and in vitro 56 fertilization used in the treatment of infertility with unlimited embryo
A. 7175 4 1 transfers from fresh or frozen oocytes or embryos from a covered 2 retrieval. Coverage may be subject to annual deductibles and coinsu- 3 rance, including copayments, as may be deemed appropriate by the super- 4 intendent and as are consistent with those established for other bene- 5 fits within a given policy. 6 (vii) (I) For the purposes of this paragraph, "infertility" means a 7 disease or condition characterized by the incapacity to impregnate 8 another person or to conceive, defined by the failure to establish a 9 clinical pregnancy after twelve months of regular, unprotected sexual 10 intercourse or therapeutic donor insemination, or after six months of 11 regular, unprotected sexual intercourse or therapeutic donor insemina- 12 tion for a female thirty-five years of age or older. Earlier evaluation 13 and treatment may be warranted based on an individual's medical history 14 or physical findings. 15 (II) For purposes of this [subparagraph] paragraph, "iatrogenic infer- 16 tility" means an impairment of fertility by surgery, radiation, chemoth- 17 erapy or other medical treatment affecting reproductive organs or proc- 18 esses. 19 [(ii)] (viii) No insurer providing coverage under this paragraph shall 20 discriminate based on an insured's expected length of life, present or 21 predicted disability, degree of medical dependency, perceived quality of 22 life, or other health conditions, nor based on personal characteristics, 23 including age, sex, sexual orientation, marital status or gender identi- 24 ty. 25 (D) Every policy that provides coverage for prescription fertility 26 drugs and requires or permits prescription drugs to be purchased through 27 a network participating mail order or other non-retail pharmacy shall 28 provide the same coverage for prescription fertility drugs when such 29 drugs are purchased from a network participating non-mail order retail 30 pharmacy provided that the network participating non-mail order retail 31 pharmacy agrees in advance through a contractual network agreement, to 32 the same reimbursement amount, as well as the same applicable terms and 33 conditions, that the insurer has established for a network participating 34 mail order or other non-retail pharmacy. In such case, the policy shall 35 not impose any fee, co-payment, coinsurance, deductible or other condi- 36 tion on any covered person who elects to purchase prescription fertility 37 drugs through a network participating non-mail order retail pharmacy 38 that it does not impose on any covered person who purchases prescription 39 fertility drugs through a network participating mail order or other 40 non-retail pharmacy; provided, however, that the provisions of this 41 section shall not supersede the terms of a collective bargaining agree- 42 ment or apply to a policy that is the result of a collective bargaining 43 agreement between an employer and a recognized or certified employee 44 organization. 45 § 4. This act shall take effect January 1, 2026, and shall apply to 46 policies and contracts issued, renewed, modified, altered or amended on 47 or after such date.