2023 -- H 5351
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LC000037
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Representatives Alzate, Felix, Giraldo, Potter, Sanchez, Henries,
Speakman, Batista, and Kazarian
Date Introduced: February 03, 2023
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Sections 27-18-30 and 27-18-52 of the General Laws in Chapter 27-18 1
entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows: 2
27-18-30. Health insurance contracts — Infertility. 3
(a) Any health insurance contract, plan, or policy delivered or issued for delivery or 4
renewed in this state, except contracts providing supplemental coverage to Medicare or other 5
governmental programs, that includes pregnancy-related benefits, shall provide coverage for 6
medically necessary expenses of diagnosis and treatment of infertility for women between the ages 7
of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in 8
conjunction with in vitro fertilization (IVF), and for standard fertility-preservation services when a 9
medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a 10
covered person. To the extent that a health insurance contract provides reimbursement for a test or 11
procedure used in the diagnosis or treatment of conditions other than infertility, the tests and 12
procedures shall not be excluded from reimbursement when provided attendant to the diagnosis 13
and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) 14
years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required 15
for those programs and/or procedures the sole purpose of which is the treatment of infertility. 16
(b) For purposes of this section, “infertility” means the condition of an otherwise 17
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 18
one year. 19
LC000037 - Page 2 of 12
(c) For purposes of this section, “standard fertility-preservation services” means 1
procedures consistent with established medical practices and professional guidelines published by 2
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 3
other reputable professional medical organizations. 4
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 5
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 6
processes. 7
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 8
likely side effect of infertility as established by the American Society for Reproductive Medicine, 9
the American Society of Clinical Oncology, or other reputable professional organizations. 10
(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 11
this section shall apply to blanket or group policies of insurance. 12
(g) The health insurance contract may limit coverage to a lifetime cap of one hundred 13
thousand dollars ($100,000). 14
(h) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 15
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 16
disorders prior to their transfer to the uterus. 17
27-18-52. Genetic testing. 18
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 19
providers shall be prohibited from releasing genetic information without prior written authorization 20
of the individual. Written authorization shall be required for each disclosure and include to whom 21
the disclosure is being made. An exception shall exist for those participating in research settings 22
governed by the Federal Policy for the Protection of Human Research Subjects (also known as 23
“The Common Rule”). Tests conducted purely for research are excluded from the definition, as are 24
tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 25
(b) No individual or group health insurance contract, plan, or policy delivered, issued for 26
delivery, or renewed in this state which provides health insurance medical coverage that includes 27
coverage for physician services in a physician’s office, and every policy which provides major 28
medical or similar comprehensive-type coverage excluding disability income, long term care and 29
insurance supplemental policies which only provide coverage for specified diseases or other 30
supplemental policies, shall: 31
(1) Use a genetic test or request for genetic tests or the results of a genetic test to reject, 32
deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect 33
a group or an individual health insurance policy, contract, or plan; 34
LC000037 - Page 3 of 12
(2) Request or require a genetic test for the purpose of determining whether or not to issue 1
or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine 2
covered benefits and services; 3
(3) Release the results of a genetic test without the prior written authorization of the 4
individual from whom the test was obtained, except in a format whereby individual identifiers are 5
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 6
of information pursuant to this section may use or disclose this information solely to carry out the 7
purpose for which the information was disclosed. Authorization shall be required for each 8
redisclosure; an exception shall exist for participating in research settings governed by the Federal 9
Policy for the Protection of Human Research Subjects (also known as “The Common Rule”). 10
(4) Request or require information as to whether an individual has ever had a genetic test, 11
or participated in genetic testing of any kind, whether for clinical or research purposes. 12
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 13
RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 14
genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include 15
predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 16
prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 17
included provided there is an approved release by a parent or guardian. Tests for metabolites are 18
covered only when they are undertaken with high probability that an excess of deficiency of the 19
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 20
mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 21
or for HIV infections. 22
(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 23
renewed in this state, except contracts providing supplemental coverage to Medicare or other 24
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 25
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 26
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 27
in vitro fertilization (IVF). For purposes of this section: 28
(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 29
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 30
to the uterus; 31
(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 32
unable to conceive or sustain a pregnancy during a period of one year. 33
SECTION 2. Sections 27-19-23 and 27-19-44 of the General Laws in Chapter 27-19 34
LC000037 - Page 4 of 12
entitled "Nonprofit Hospital Service Corporations" are hereby amended to read as follows: 1
27-19-23. Coverage for infertility. 2
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for 3
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 4
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 5
for medically necessary expenses of diagnosis and treatment of infertility for women between the 6
ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis 7
(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation 8
services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 9
infertility to a covered person. To the extent that a nonprofit hospital service corporation provides 10
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 11
infertility, those tests and procedures shall not be excluded from reimbursement when provided 12
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 13
(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent 14
(20%), may be required for those programs and/or procedures the sole purpose of which is the 15
treatment of infertility. 16
(b) For purposes of this section, “infertility” means the condition of an otherwise 17
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 18
one year. 19
(c) For purposes of this section, “standard fertility-preservation services” means 20
procedures consistent with established medical practices and professional guidelines published by 21
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 22
other reputable professional medical organizations. 23
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 24
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 25
processes. 26
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 27
likely side effect of infertility as established by the American Society for Reproductive Medicine, 28
the American Society of Clinical Oncology, or other reputable professional organizations. 29
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 30
thousand dollars ($100,000). 31
(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 32
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 33
disorders prior to their transfer to the uterus. 34
LC000037 - Page 5 of 12
27-19-44. Genetic testing. 1
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 2
providers shall be prohibited from releasing genetic information without prior written authorization 3
of the individual. Written authorization shall be required for each disclosure and include to whom 4
the disclosure is being made. An exception shall exist for those participating in research settings 5
governed by the federal policy for the protection of human research subjects (also known as “The 6
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 7
for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 8
(b) No nonprofit health service corporation subject to the provisions of this chapter shall: 9
(1) Use a genetic test or request for a genetic test or the results of a genetic test or other 10
genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the 11
terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or 12
plan; 13
(2) Request or require a genetic test for the purpose of determining whether or not to issue 14
or renew a group, individual health benefits coverage to set reimbursement/co-pay levels or 15
determine covered benefits and services; 16
(3) Release the results of a genetic test without the prior written authorization of the 17
individual from whom the test was obtained, except in a format by which individual identifiers are 18
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 19
of information pursuant to this section may use or disclose the information solely to carry out the 20
purpose for which the information was disclosed. Authorization shall be required for each 21
redisclosure. An exception shall exist for participation in research settings governed by the federal 22
policy for the protection of human research subjects (also known as “The Common Rule”); 23
(4) Request or require information as to whether an individual has ever had a genetic test, 24
or participated in genetic testing of any kind, whether for clinical or research purposes. 25
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 26
RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 27
genotypes, mutations, phenotypes or karyotypes for clinical purposes. These purposes include 28
predicating risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 29
prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 30
included provided there is an approved release by a parent or guardian. Tests for metabolites are 31
covered only when they are undertaken with high probability that an excess of deficiency of the 32
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 33
mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs 34
LC000037 - Page 6 of 12
or for HIV infection. 1
(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 2
renewed in this state, except contracts providing supplemental coverage to Medicare or other 3
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 4
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 5
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 6
in vitro fertilization (IVF). For purposes of this section: 7
(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 8
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 9
to the uterus; 10
(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 11
unable to conceive or sustain a pregnancy during a period of one year. 12
SECTION 3. Section 27-20-20 and 27-20-39 of the General Laws in Chapter 27-20 entitled 13
"Nonprofit Medical Service Corporations" are hereby amended to read as follows: 14
27-20-20. Coverage for infertility. 15
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for 16
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 17
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 18
for the medically necessary expenses of diagnosis and treatment of infertility for women between 19
the ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis 20
(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation 21
services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 22
infertility to a covered person. To the extent that a nonprofit medical service corporation provides 23
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 24
infertility, those tests and procedures shall not be excluded from reimbursement when provided 25
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 26
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 27
(20%), may be required for those programs and/or procedures the sole purpose of which is the 28
treatment of infertility. 29
(b) For purposes of this section, “infertility” means the condition of an otherwise 30
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 31
one year. 32
(c) For purposes of this section, “standard fertility-preservation services” means 33
procedures consistent with established medical practices and professional guidelines published by 34
LC000037 - Page 7 of 12
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1
other reputable professional medical organizations. 2
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 3
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 4
processes. 5
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 6
likely side effect of infertility as established by the American Society for Reproductive Medicine, 7
the American Society of Clinical Oncology, or other reputable professional organizations. 8
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 9
thousand dollars ($100,000). 10
(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 11
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 12
disorders prior to their transfer to the uterus. 13
27-20-39. Genetic testing. 14
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 15
providers shall be prohibited from releasing genetic information without prior written authorization 16
of the individual. Written authorization shall be required for each disclosure and include to whom 17
the disclosure is being made. An exception shall exist for those participating in research settings 18
governed by the federal policy for the protection of human research subjects (also known as “The 19
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 20
for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 21
(b) No nonprofit health insurer subject to the provisions of this chapter shall: 22
(1) Use a genetic test or request for a genetic test or the results of a genetic test to reject, 23
deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect 24
a group or individual’s health insurance policy, contract, or plan; 25
(2) Request or require a genetic test for the purpose of determining whether or not to issue 26
or renew health benefits coverage, to set reimbursement/co-pay levels or determine covered 27
benefits and services; 28
(3) Release the results of a genetic test without the prior written authorization of the 29
individual from whom the test was obtained, except in a format by which individual identifiers are 30
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 31
of information pursuant to this section may use or disclose the information solely to carry out the 32
purpose for which the information was disclosed. Authorization shall be required for each 33
redisclosure. An exception shall exist for participation in research settings governed by the federal 34
LC000037 - Page 8 of 12
policy for the protection of human research subjects (also known as “The Common Rule”); or 1
(4) Request or require information as to whether an individual has ever had a genetic test, 2
or participated in genetic testing of any kind, whether for clinical or research purposes. 3
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 4
RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 5
genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include 6
predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 7
prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 8
included provided there is an approved release by a parent or guardian. Tests for metabolites are 9
covered only when they are undertaken with high probability that an excess of deficiency of the 10
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 11
mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 12
or for HIV infections. 13
(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 14
renewed in this state, except contracts providing supplemental coverage to Medicare or other 15
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 16
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 17
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 18
in vitro fertilization (IVF). For purposes of this section: 19
(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 20
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 21
to the uterus; 22
(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 23
unable to conceive or sustain a pregnancy during a period of one year. 24
SECTION 4. Sections 27-41-33 and 27-41-53 of the General Laws in Chapter 27-41 25
entitled "Health Maintenance Organizations" are hereby amended to read as follows: 26
27-41-33. Coverage for infertility. 27
(a) Any health maintenance organization service contract plan or policy delivered, issued 28
for delivery, or renewed in this state, except a contract providing supplemental coverage to 29
Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide 30
coverage for medically necessary expenses of diagnosis and treatment of infertility for women 31
between the ages of twenty-five (25) and forty-two (42), including preimplantation genetic 32
diagnosis (PGD) in conjunction with in vitro fertilization (IVF), years and for standard fertility-33
preservation services when a medically necessary medical treatment may directly or indirectly 34
LC000037 - Page 9 of 12
cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization 1
provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions 2
other than infertility, those tests and procedures shall not be excluded from reimbursement when 3
provided attendant to the diagnosis and treatment of infertility for women between the ages of 4
twenty-five (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed 5
twenty percent (20%), may be required for those programs and/or procedures the sole purpose of 6
which is the treatment of infertility. 7
(b) For purposes of this section, “infertility” means the condition of an otherwise healthy 8
individual who is unable to conceive or sustain a pregnancy during a period of one year. 9
(c) For purposes of this section, “standard fertility-preservation services” means 10
procedures consistent with established medical practices and professional guidelines published by 11
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 12
other reputable professional medical organizations. 13
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 14
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 15
processes. 16
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 17
likely side effect of infertility as established by the American Society for Reproductive Medicine, 18
the American Society of Clinical Oncology, or other reputable professional organizations. 19
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 20
thousand dollars ($100,000). 21
(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 22
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 23
disorders prior to their transfer to the uterus. 24
27-41-53. Genetic testing. 25
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 26
providers shall be prohibited from releasing genetic information without prior written authorization 27
of the individual. Written authorization shall be required for each disclosure and include to whom 28
the disclosure is being made. An exception shall exist for those participating in research settings 29
governed by the federal policy for the protection of human research subjects (also known as “The 30
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 31
for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 32
(b) No health maintenance organization subject to the provisions of this chapter shall: 33
(1) Use a genetic test or request for genetic test the results of a genetic test to reject, deny, 34
LC000037 - Page 10 of 12
limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a 1
group or an individual’s health insurance policy contract, or plan; 2
(2) Request or require a genetic test for the purpose of determining whether or not to issue 3
or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine 4
covered benefits and services; 5
(3) Release the results of a genetic test without the prior written authorization of the 6
individual from whom the test was obtained, except in a format where individual identifiers are 7
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 8
of information pursuant to this section may use or disclose the information solely to carry out the 9
purpose for which the information was disclosed. Authorization shall be required for each re-10
disclosure. An exception shall exist for participation in research settings governed by the federal 11
policy for the protection of human research subjects (also known as “The Common Rule”); or 12
(4) Request or require information as to whether an individual has ever had a genetic test, 13
or participated in genetic testing of any kind, whether for clinical or research purposes. 14
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 15
RNA, chromosomes, protein and certain metabolites in order to detect heritable inheritable disease-16
related genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes 17
include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis 18
or prognosis. Prenatal, newborn and carrier screening, and testing in high risk families may be 19
included provided there is an approved release by a parent or guardian. Tests for metabolites are 20
covered only when they are undertaken with high probability that an excess or deficiency of the 21
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 22
mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 23
or for HIV infections. 24
(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 25
renewed in this state, except contracts providing supplemental coverage to Medicare or other 26
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 27
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 28
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 29
in vitro fertilization (IVF). For purposes of this section: 30
(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 31
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 32
to the uterus; 33
(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 34
LC000037 - Page 11 of 12
unable to conceive or sustain a pregnancy during a period of one year. 1
SECTION 5. This act shall take effect on January 1, 2024. 2
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LC000037
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This act would mandate all insurance contracts, plans or policies provide insurance 1
coverage for the expense of diagnosing and treating infertility for women between the ages of 2
twenty-five and forty-two years including preimplantation genetic diagnosis (PGD) in conjunction 3
with in vitro fertilization (IVF). 4
This act would take effect on January 1, 2024. 5
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LC000037
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