Rhode Island 2023 Regular Session

Rhode Island House Bill H5351 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- H 5351
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7	7	LC000037
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Representatives Alzate, Felix, Giraldo, Potter, Sanchez, Henries,
17	17	Speakman, Batista, and Kazarian
18	18	Date Introduced: February 03, 2023
19	19	Referred To: House Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Sections 27-18-30 and 27-18-52 of the General Laws in Chapter 27-18 1
24	24	entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows: 2
25	25	27-18-30. Health insurance contracts — Infertility. 3
26	26	(a) Any health insurance contract, plan, or policy delivered or issued for delivery or 4
27	27	renewed in this state, except contracts providing supplemental coverage to Medicare or other 5
28	28	governmental programs, that includes pregnancy-related benefits, shall provide coverage for 6
29	29	medically necessary expenses of diagnosis and treatment of infertility for women between the ages 7
30	30	of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in 8
31	31	conjunction with in vitro fertilization (IVF), and for standard fertility-preservation services when a 9
32	32	medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a 10
33	33	covered person. To the extent that a health insurance contract provides reimbursement for a test or 11
34	34	procedure used in the diagnosis or treatment of conditions other than infertility, the tests and 12
35	35	procedures shall not be excluded from reimbursement when provided attendant to the diagnosis 13
36	36	and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) 14
37	37	years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required 15
38	38	for those programs and/or procedures the sole purpose of which is the treatment of infertility. 16
39	39	(b) For purposes of this section, “infertility” means the condition of an otherwise 17
40	40	presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 18
41	41	one year. 19
42	42
43	43
44	44	LC000037 - Page 2 of 12
45	45	(c) For purposes of this section, “standard fertility-preservation services” means 1
46	46	procedures consistent with established medical practices and professional guidelines published by 2
47	47	the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 3
48	48	other reputable professional medical organizations. 4
49	49	(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 5
50	50	surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 6
51	51	processes. 7
52	52	(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 8
53	53	likely side effect of infertility as established by the American Society for Reproductive Medicine, 9
54	54	the American Society of Clinical Oncology, or other reputable professional organizations. 10
55	55	(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 11
56	56	this section shall apply to blanket or group policies of insurance. 12
57	57	(g) The health insurance contract may limit coverage to a lifetime cap of one hundred 13
58	58	thousand dollars ($100,000). 14
59	59	(h) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 15
60	60	technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 16
61	61	disorders prior to their transfer to the uterus. 17
62	62	27-18-52. Genetic testing. 18
63	63	(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 19
64	64	providers shall be prohibited from releasing genetic information without prior written authorization 20
65	65	of the individual. Written authorization shall be required for each disclosure and include to whom 21
66	66	the disclosure is being made. An exception shall exist for those participating in research settings 22
67	67	governed by the Federal Policy for the Protection of Human Research Subjects (also known as 23
68	68	“The Common Rule”). Tests conducted purely for research are excluded from the definition, as are 24
69	69	tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 25
70	70	(b) No individual or group health insurance contract, plan, or policy delivered, issued for 26
71	71	delivery, or renewed in this state which provides health insurance medical coverage that includes 27
72	72	coverage for physician services in a physician’s office, and every policy which provides major 28
73	73	medical or similar comprehensive-type coverage excluding disability income, long term care and 29
74	74	insurance supplemental policies which only provide coverage for specified diseases or other 30
75	75	supplemental policies, shall: 31
76	76	(1) Use a genetic test or request for genetic tests or the results of a genetic test to reject, 32
77	77	deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect 33
78	78	a group or an individual health insurance policy, contract, or plan; 34
79	79
80	80
81	81	LC000037 - Page 3 of 12
82	82	(2) Request or require a genetic test for the purpose of determining whether or not to issue 1
83	83	or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine 2
84	84	covered benefits and services; 3
85	85	(3) Release the results of a genetic test without the prior written authorization of the 4
86	86	individual from whom the test was obtained, except in a format whereby individual identifiers are 5
87	87	removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 6
88	88	of information pursuant to this section may use or disclose this information solely to carry out the 7
89	89	purpose for which the information was disclosed. Authorization shall be required for each 8
90	90	redisclosure; an exception shall exist for participating in research settings governed by the Federal 9
91	91	Policy for the Protection of Human Research Subjects (also known as “The Common Rule”). 10
92	92	(4) Request or require information as to whether an individual has ever had a genetic test, 11
93	93	or participated in genetic testing of any kind, whether for clinical or research purposes. 12
94	94	(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 13
95	95	RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 14
96	96	genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include 15
97	97	predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 16
98	98	prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 17
99	99	included provided there is an approved release by a parent or guardian. Tests for metabolites are 18
100	100	covered only when they are undertaken with high probability that an excess of deficiency of the 19
101	101	metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 20
102	102	mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 21
103	103	or for HIV infections. 22
104	104	(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 23
105	105	renewed in this state, except contracts providing supplemental coverage to Medicare or other 24
106	106	governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 25
107	107	expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 26
108	108	and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 27
109	109	in vitro fertilization (IVF). For purposes of this section: 28
110	110	(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 29
111	111	with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 30
112	112	to the uterus; 31
113	113	(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 32
114	114	unable to conceive or sustain a pregnancy during a period of one year. 33
115	115	SECTION 2. Sections 27-19-23 and 27-19-44 of the General Laws in Chapter 27-19 34
116	116
117	117
118	118	LC000037 - Page 4 of 12
119	119	entitled "Nonprofit Hospital Service Corporations" are hereby amended to read as follows: 1
120	120	27-19-23. Coverage for infertility. 2
121	121	(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for 3
122	122	delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 4
123	123	or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 5
124	124	for medically necessary expenses of diagnosis and treatment of infertility for women between the 6
125	125	ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis 7
126	126	(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation 8
127	127	services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 9
128	128	infertility to a covered person. To the extent that a nonprofit hospital service corporation provides 10
129	129	reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 11
130	130	infertility, those tests and procedures shall not be excluded from reimbursement when provided 12
131	131	attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 13
132	132	(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent 14
133	133	(20%), may be required for those programs and/or procedures the sole purpose of which is the 15
134	134	treatment of infertility. 16
135	135	(b) For purposes of this section, “infertility” means the condition of an otherwise 17
136	136	presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 18
137	137	one year. 19
138	138	(c) For purposes of this section, “standard fertility-preservation services” means 20
139	139	procedures consistent with established medical practices and professional guidelines published by 21
140	140	the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 22
141	141	other reputable professional medical organizations. 23
142	142	(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 24
143	143	surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 25
144	144	processes. 26
145	145	(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 27
146	146	likely side effect of infertility as established by the American Society for Reproductive Medicine, 28
147	147	the American Society of Clinical Oncology, or other reputable professional organizations. 29
148	148	(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 30
149	149	thousand dollars ($100,000). 31
150	150	(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 32
151	151	technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 33
152	152	disorders prior to their transfer to the uterus. 34
153	153
154	154
155	155	LC000037 - Page 5 of 12
156	156	27-19-44. Genetic testing. 1
157	157	(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 2
158	158	providers shall be prohibited from releasing genetic information without prior written authorization 3
159	159	of the individual. Written authorization shall be required for each disclosure and include to whom 4
160	160	the disclosure is being made. An exception shall exist for those participating in research settings 5
161	161	governed by the federal policy for the protection of human research subjects (also known as “The 6
162	162	Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 7
163	163	for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 8
164	164	(b) No nonprofit health service corporation subject to the provisions of this chapter shall: 9
165	165	(1) Use a genetic test or request for a genetic test or the results of a genetic test or other 10
166	166	genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the 11
167	167	terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or 12
168	168	plan; 13
169	169	(2) Request or require a genetic test for the purpose of determining whether or not to issue 14
170	170	or renew a group, individual health benefits coverage to set reimbursement/co-pay levels or 15
171	171	determine covered benefits and services; 16
172	172	(3) Release the results of a genetic test without the prior written authorization of the 17
173	173	individual from whom the test was obtained, except in a format by which individual identifiers are 18
174	174	removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 19
175	175	of information pursuant to this section may use or disclose the information solely to carry out the 20
176	176	purpose for which the information was disclosed. Authorization shall be required for each 21
177	177	redisclosure. An exception shall exist for participation in research settings governed by the federal 22
178	178	policy for the protection of human research subjects (also known as “The Common Rule”); 23
179	179	(4) Request or require information as to whether an individual has ever had a genetic test, 24
180	180	or participated in genetic testing of any kind, whether for clinical or research purposes. 25
181	181	(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 26
182	182	RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 27
183	183	genotypes, mutations, phenotypes or karyotypes for clinical purposes. These purposes include 28
184	184	predicating risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 29
185	185	prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 30
186	186	included provided there is an approved release by a parent or guardian. Tests for metabolites are 31
187	187	covered only when they are undertaken with high probability that an excess of deficiency of the 32
188	188	metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 33
189	189	mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs 34
190	190
191	191
192	192	LC000037 - Page 6 of 12
193	193	or for HIV infection. 1
194	194	(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 2
195	195	renewed in this state, except contracts providing supplemental coverage to Medicare or other 3
196	196	governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 4
197	197	expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 5
198	198	and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 6
199	199	in vitro fertilization (IVF). For purposes of this section: 7
200	200	(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 8
201	201	with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 9
202	202	to the uterus; 10
203	203	(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 11
204	204	unable to conceive or sustain a pregnancy during a period of one year. 12
205	205	SECTION 3. Section 27-20-20 and 27-20-39 of the General Laws in Chapter 27-20 entitled 13
206	206	"Nonprofit Medical Service Corporations" are hereby amended to read as follows: 14
207	207	27-20-20. Coverage for infertility. 15
208	208	(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for 16
209	209	delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 17
210	210	or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 18
211	211	for the medically necessary expenses of diagnosis and treatment of infertility for women between 19
212	212	the ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis 20
213	213	(PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation 21
214	214	services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 22
215	215	infertility to a covered person. To the extent that a nonprofit medical service corporation provides 23
216	216	reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 24
217	217	infertility, those tests and procedures shall not be excluded from reimbursement when provided 25
218	218	attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 26
219	219	(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 27
220	220	(20%), may be required for those programs and/or procedures the sole purpose of which is the 28
221	221	treatment of infertility. 29
222	222	(b) For purposes of this section, “infertility” means the condition of an otherwise 30
223	223	presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 31
224	224	one year. 32
225	225	(c) For purposes of this section, “standard fertility-preservation services” means 33
226	226	procedures consistent with established medical practices and professional guidelines published by 34
227	227
228	228
229	229	LC000037 - Page 7 of 12
230	230	the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1
231	231	other reputable professional medical organizations. 2
232	232	(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 3
233	233	surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 4
234	234	processes. 5
235	235	(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 6
236	236	likely side effect of infertility as established by the American Society for Reproductive Medicine, 7
237	237	the American Society of Clinical Oncology, or other reputable professional organizations. 8
238	238	(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 9
239	239	thousand dollars ($100,000). 10
240	240	(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 11
241	241	technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 12
242	242	disorders prior to their transfer to the uterus. 13
243	243	27-20-39. Genetic testing. 14
244	244	(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 15
245	245	providers shall be prohibited from releasing genetic information without prior written authorization 16
246	246	of the individual. Written authorization shall be required for each disclosure and include to whom 17
247	247	the disclosure is being made. An exception shall exist for those participating in research settings 18
248	248	governed by the federal policy for the protection of human research subjects (also known as “The 19
249	249	Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 20
250	250	for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 21
251	251	(b) No nonprofit health insurer subject to the provisions of this chapter shall: 22
252	252	(1) Use a genetic test or request for a genetic test or the results of a genetic test to reject, 23
253	253	deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect 24
254	254	a group or individual’s health insurance policy, contract, or plan; 25
255	255	(2) Request or require a genetic test for the purpose of determining whether or not to issue 26
256	256	or renew health benefits coverage, to set reimbursement/co-pay levels or determine covered 27
257	257	benefits and services; 28
258	258	(3) Release the results of a genetic test without the prior written authorization of the 29
259	259	individual from whom the test was obtained, except in a format by which individual identifiers are 30
260	260	removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 31
261	261	of information pursuant to this section may use or disclose the information solely to carry out the 32
262	262	purpose for which the information was disclosed. Authorization shall be required for each 33
263	263	redisclosure. An exception shall exist for participation in research settings governed by the federal 34
264	264
265	265
266	266	LC000037 - Page 8 of 12
267	267	policy for the protection of human research subjects (also known as “The Common Rule”); or 1
268	268	(4) Request or require information as to whether an individual has ever had a genetic test, 2
269	269	or participated in genetic testing of any kind, whether for clinical or research purposes. 3
270	270	(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 4
271	271	RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related 5
272	272	genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include 6
273	273	predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or 7
274	274	prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be 8
275	275	included provided there is an approved release by a parent or guardian. Tests for metabolites are 9
276	276	covered only when they are undertaken with high probability that an excess of deficiency of the 10
277	277	metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 11
278	278	mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 12
279	279	or for HIV infections. 13
280	280	(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 14
281	281	renewed in this state, except contracts providing supplemental coverage to Medicare or other 15
282	282	governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 16
283	283	expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 17
284	284	and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 18
285	285	in vitro fertilization (IVF). For purposes of this section: 19
286	286	(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 20
287	287	with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 21
288	288	to the uterus; 22
289	289	(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 23
290	290	unable to conceive or sustain a pregnancy during a period of one year. 24
291	291	SECTION 4. Sections 27-41-33 and 27-41-53 of the General Laws in Chapter 27-41 25
292	292	entitled "Health Maintenance Organizations" are hereby amended to read as follows: 26
293	293	27-41-33. Coverage for infertility. 27
294	294	(a) Any health maintenance organization service contract plan or policy delivered, issued 28
295	295	for delivery, or renewed in this state, except a contract providing supplemental coverage to 29
296	296	Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide 30
297	297	coverage for medically necessary expenses of diagnosis and treatment of infertility for women 31
298	298	between the ages of twenty-five (25) and forty-two (42), including preimplantation genetic 32
299	299	diagnosis (PGD) in conjunction with in vitro fertilization (IVF), years and for standard fertility-33
300	300	preservation services when a medically necessary medical treatment may directly or indirectly 34
301	301
302	302
303	303	LC000037 - Page 9 of 12
304	304	cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization 1
305	305	provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions 2
306	306	other than infertility, those tests and procedures shall not be excluded from reimbursement when 3
307	307	provided attendant to the diagnosis and treatment of infertility for women between the ages of 4
308	308	twenty-five (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed 5
309	309	twenty percent (20%), may be required for those programs and/or procedures the sole purpose of 6
310	310	which is the treatment of infertility. 7
311	311	(b) For purposes of this section, “infertility” means the condition of an otherwise healthy 8
312	312	individual who is unable to conceive or sustain a pregnancy during a period of one year. 9
313	313	(c) For purposes of this section, “standard fertility-preservation services” means 10
314	314	procedures consistent with established medical practices and professional guidelines published by 11
315	315	the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 12
316	316	other reputable professional medical organizations. 13
317	317	(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 14
318	318	surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 15
319	319	processes. 16
320	320	(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 17
321	321	likely side effect of infertility as established by the American Society for Reproductive Medicine, 18
322	322	the American Society of Clinical Oncology, or other reputable professional organizations. 19
323	323	(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 20
324	324	thousand dollars ($100,000). 21
325	325	(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a 22
326	326	technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic 23
327	327	disorders prior to their transfer to the uterus. 24
328	328	27-41-53. Genetic testing. 25
329	329	(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and 26
330	330	providers shall be prohibited from releasing genetic information without prior written authorization 27
331	331	of the individual. Written authorization shall be required for each disclosure and include to whom 28
332	332	the disclosure is being made. An exception shall exist for those participating in research settings 29
333	333	governed by the federal policy for the protection of human research subjects (also known as “The 30
334	334	Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests 31
335	335	for somatic (as opposed to heritable) mutations, and testing for forensic purposes. 32
336	336	(b) No health maintenance organization subject to the provisions of this chapter shall: 33
337	337	(1) Use a genetic test or request for genetic test the results of a genetic test to reject, deny, 34
338	338
339	339
340	340	LC000037 - Page 10 of 12
341	341	limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect a 1
342	342	group or an individual’s health insurance policy contract, or plan; 2
343	343	(2) Request or require a genetic test for the purpose of determining whether or not to issue 3
344	344	or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine 4
345	345	covered benefits and services; 5
346	346	(3) Release the results of a genetic test without the prior written authorization of the 6
347	347	individual from whom the test was obtained, except in a format where individual identifiers are 7
348	348	removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient 8
349	349	of information pursuant to this section may use or disclose the information solely to carry out the 9
350	350	purpose for which the information was disclosed. Authorization shall be required for each re-10
351	351	disclosure. An exception shall exist for participation in research settings governed by the federal 11
352	352	policy for the protection of human research subjects (also known as “The Common Rule”); or 12
353	353	(4) Request or require information as to whether an individual has ever had a genetic test, 13
354	354	or participated in genetic testing of any kind, whether for clinical or research purposes. 14
355	355	(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA, 15
356	356	RNA, chromosomes, protein and certain metabolites in order to detect heritable inheritable disease-16
357	357	related genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes 17
358	358	include predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis 18
359	359	or prognosis. Prenatal, newborn and carrier screening, and testing in high risk families may be 19
360	360	included provided there is an approved release by a parent or guardian. Tests for metabolites are 20
361	361	covered only when they are undertaken with high probability that an excess or deficiency of the 21
362	362	metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not 22
363	363	mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs 23
364	364	or for HIV infections. 24
365	365	(d) Any health insurance contract, plan, or policy delivered or issued for delivery or 25
366	366	renewed in this state, except contracts providing supplemental coverage to Medicare or other 26
367	367	governmental programs, that includes pregnancy-related benefits, shall provide coverage for the 27
368	368	expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) 28
369	369	and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with 29
370	370	in vitro fertilization (IVF). For purposes of this section: 30
371	371	(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction 31
372	372	with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer 32
373	373	to the uterus; 33
374	374	(2) "Infertility" means the condition of an otherwise presumably healthy individual who is 34
375	375
376	376
377	377	LC000037 - Page 11 of 12
378	378	unable to conceive or sustain a pregnancy during a period of one year. 1
379	379	SECTION 5. This act shall take effect on January 1, 2024. 2
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381	381	LC000037
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385	385	LC000037 - Page 12 of 12
386	386	EXPLANATION
387	387	BY THE LEGISLATIVE COUNCIL
388	388	OF
389	389	A N A C T
390	390	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
391	391	***
392	392	This act would mandate all insurance contracts, plans or policies provide insurance 1
393	393	coverage for the expense of diagnosing and treating infertility for women between the ages of 2
394	394	twenty-five and forty-two years including preimplantation genetic diagnosis (PGD) in conjunction 3
395	395	with in vitro fertilization (IVF). 4
396	396	This act would take effect on January 1, 2024. 5
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398	398	LC000037
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