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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
HOUSE BILL 3841 By: Pittman
AS INTRODUCED
An Act relating to infertility insurance coverage;
defining terms; requiring insurance coverage for
certain infertility care; specifying terms of
coverage; providing for codification ; and providing
an effective date.
BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.2a of Title 36, unless
there is created a duplication in numbering, reads as follows:
As used in this act:
1. "ACOG" means the American College of Obstetricians and
Gynecologists or its successor organization ;
2. "ASCO" means the American Society of Clinical Oncology or
its successor organization ;
3. "ASRM" means the American Society for Reproductive Medicine
or its successor organization;
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4. "Diagnosis of and treatment for infertility " means the
procedures and medication s recommended by a licensed physician that
are consistent with established, published, or approved medical
practices or professional guidelines from ACOG or ASRM for
diagnosing and treating infertility ;
5. "Infertility" means a disease or condition charac terized by:
a. the failure to impregnate or conceive ,
b. a person's inability to reproduce either as an
individual or with the person 's partner, or
c. a licensed physician 's findings based on a patient 's
medical, sexual, and reproductive history, age,
physical findings, or diagnostic testing;
6. "Licensed physician" means a person licensed by the Oklahoma
State Board of Medical Licensure and Supervision or the State Board
of Osteopathic Examiners to practice medicine in this state ; and
7. "Standard fertility preservation services" means procedures
and services that are consistent with esta blished medical practices
or professional guidelines published by ASRM or ASCO for a person
who has a medical condition or is expected to undergo medication
therapy, surgery, radiation, chemotherapy, or other medical
treatment that is recognized by medic al professionals to cause a
risk of impairment to fertility .
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SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Sect ion 6060.2b of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. All individual and group health benefit plans issued or
renewed in this state, including any insurance plan provided by the
Employee Group Insurance Division of the Office of Management and
Enterprise Services, shall provide coverage for the diagnosis of and
treatment for infertility and standard fertility preser vation
services.
B. The coverage required by this act includes three completed
oocyte retrievals with unlimited embryo transfers in accordance with
the guidelines of the American Society of Clinical Oncology , using
single embryo transfer when recommended and medically appropriate.
C. The health benefit plan shall not impose:
1. Any exclusions, limita tions, or other restrictions on
coverage of fertility medications that are different from the
exclusions, limitations, or other restrictions imposed on any o ther
prescription medications covered under the health benefit plan; or
2. Deductibles, copayment s, coinsurance, benefit maximums,
waiting periods, or other limitations on coverage for the diagnosis
of and treatment for infertility and standard fertility preservation
services, except as otherwise specified in this act, that are
different from deductib les, copayments, coinsurance, benefit
maximums, waiting periods, or other limitations imposed on benefits
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for services covered under the health benefit plan that are not
related to infertility.
D. The Oklahoma Insurance Commissioner shall adopt rules
consistent with and as are necessary to implement this act.
E. A religious employer may request and a carrier subject to
this act shall grant an exclusion from the coverage required under
this act in a health benefit plan if the required coverage conflicts
with the religious organization's bona fide religious beliefs and
practices. A religious employer that obtains an exclusion under
this act shall provide its employees reasonable and timely notice of
the exclusion of the coverage described in this act from the health
benefit plan the religious employer of fers to its employees.
F. 1. Within one hundred twenty (120) days after the effective
date of this act, the Oklahoma Insurance Department shall submit to
the federal Department of Health and Human Services its
determination as to whether the coverage spe cified in this act is in
addition to essential health benefits and would be subject to
defrayal by the state pursuant to 42 U.S.C., Section 18031 (d)(3)(b)
and a request that the federal Department confirm th e Department's
determination within sixty (60) days after receipt of the
Department's request and submission of its determination.
2. This act applies to health benefit plans issued or renewed
in this state that are subject to this act, and the Oklahoma
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Insurance Department shall implement the requireme nts of this act,
if:
a. the Department receives confirmation from the federal
Department of Health and Human Services that the
coverage specified in this act does not constitute an
additional benefit that re quires defrayal by the state
pursuant to 42 U.S.C., Section 18031 (d)(3)(b), or
b. more than three hundred sixty -five (365) days have
passed since the Department submitted its
determination and request for confirmation that the
coverage specified in this act is not an additional
benefit that requires stat e defrayal pursuant to 42
U.S.C., Section 18031 (d)(3)(b), and the federal
Department of Health and Human Services has failed to
respond to the request within that period, in which
case the Department shall consider the federal
Department's unreasonable delay a preclusion from
requiring defrayal by the state.
SECTION 3. This act shall become e ffective November 1, 2024.
59-2-9650 TJ 01/18/24