2025 -- H 5629
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LC000882
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S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND INSURANCE POLICIES
Introduced By: Representatives Alzate, Ajello, Kislak, Felix, Furtado, Stewart, Kazarian,
Cruz, Diaz, and Fogarty
Date Introduced: February 26, 2025
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident 1
and Sickness Insurance Policies" is 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 and for standard fertility-preservation services when a 8
medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a 9
covered person. To the extent that a health insurance contract provides reimbursement for a test or 10
procedure used in the diagnosis or treatment of conditions other than infertility, the tests and 11
procedures shall not be excluded from reimbursement when provided attendant to the diagnosis 12
and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) 13
years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required 14
for those programs and/or procedures the sole purpose of which is the treatment of infertility. 15
(b) For purposes of this section, “infertility” means the condition of an otherwise 16
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 17
one year. 18
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 19
LC000882 - Page 2 of 13
this section shall apply to blanket or group policies of insurance. 1
(c) For the purposes of this section, the following terms shall have the following meanings: 2
(1) “Infertility” means: 3
(i) The presence of a condition recognized by a healthcare provider as a cause of loss or 4
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 5
physical findings, diagnostic testing, or any combination of those factors; 6
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 7
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 8
partner have the necessary gametes to establish a pregnancy; 9
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected 10
sexual intercourse due to an individual's age when the individual and the individual’s partner have 11
the necessary gametes to establish pregnancy; 12
(iv) An individual’s inability to achieve pregnancy as an individual or with a partner 13
because the individual or the individual and the individual’s partner do not have the necessary 14
gametes to achieve a pregnancy; 15
(v) An individual’s increased risk, independently or with the individual’s partner, of 16
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or 17
(vi) As defined by the American Society of Reproductive Medicine, its successor 18
organization, or comparable organization. 19
(vii) Pregnancy resulting in a loss does not cause the time period of trying to establish a 20
pregnancy to be restarted. 21
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard 22
fertility-preservation services" means procedures consistent with established medical practices and 23
professional guidelines published by the American Society for Reproductive Medicine, the 24
American Society of Clinical Oncology, or other reputable professional medical organizations, its 25
successor organization, or a comparable organization, for an individual who has a medical or 26
genetic condition or who is expected to undergo treatment that has a possible side effect of or may 27
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the 28
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. 29
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 30
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 31
processes. 32
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 33
likely side effect of infertility as established by the American Society for Reproductive Medicine, 34
LC000882 - Page 3 of 13
the American Society of Clinical Oncology, or other reputable professional organizations. 1
(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 2
this section shall apply to blanket or group policies of insurance. 3
(g) The health insurance contract may limit coverage to a lifetime cap of one hundred 4
thousand dollars ($100,000). 5
(d) Coverage for the treatment of infertility under this section shall be provided without 6
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 7
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 8
or sexual orientation. 9
(e) Coverage for the treatment of infertility under this section shall include: 10
(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those 11
oocyte retrievals or from any oocyte retrieval; 12
(2) The medical costs related to an embryo transfer to be made from or on behalf of an 13
insured to a third party; and 14
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo 15
will be transferred to a surrogate. 16
(f) An insurer described in subsection (a) of this section shall not impose any of the 17
following: 18
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 19
other limitations on coverage for the diagnosis and treatment of infertility, including the 20
prescription of fertility medications, different from those imposed on benefits for services not 21
related to infertility; 22
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 23
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 24
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 25
required benefits; 26
(3) Limitations on coverage based solely on arbitrary factors, including number of 27
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 28
on, a class protected under § 23-17-19.1, than that provided to other insureds; 29
(4) Impose any limitations on coverage required under this section based on an individual's 30
use of donor gametes, donor embryos or surrogacy; 31
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 32
are different from those imposed on any other prescription medications; or 33
(6) Limitations under the policy based on anything other than the medical assessment of 34
LC000882 - Page 4 of 13
an individual’s licensed healthcare provider. 1
(g) An insurer described in subsection (a) of this section of this section shall provide 2
coverage under this section regardless of whether the insured foregoes a particular fertility 3
treatment or procedure, if the insured’s healthcare provider determines that the treatment or 4
procedures is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or 5
embryos. 6
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any 7
clinical guidelines used for a policy subject to the requirements of this section shall be based on 8
current guidelines developed by the American Society for Reproductive Medicine, its successor 9
organization, or a comparable organization such as the American Society of Clinical Oncology or 10
the American College of Obstetrics and Gynecology. 11
SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit 12
Hospital Service Corporations" is hereby amended to read as follows: 13
27-19-23. Coverage for infertility. 14
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for 15
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 16
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 17
for medically necessary expenses of diagnosis and treatment of infertility for women between the 18
ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services 19
when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility 20
to a covered person. To the extent that a nonprofit hospital service corporation provides 21
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 22
infertility, those tests and procedures shall not be excluded from reimbursement when provided 23
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 24
(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent 25
(20%), may be required for those programs and/or procedures the sole purpose of which is the 26
treatment of infertility. 27
(b) For purposes of this section, “infertility” means the condition of an otherwise 28
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 29
one year. 30
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 31
this section shall apply to blanket or group policies of insurance. 32
(c) For the purposes of this section, the following terms shall have the following meanings: 33
(1) “Infertility” means: 34
LC000882 - Page 5 of 13
(i) The presence of a condition recognized by a healthcare provider as a cause of loss or 1
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 2
physical findings, diagnostic testing, or any combination of those factors; 3
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 4
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 5
partner have the necessary gametes to establish a pregnancy; 6
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected 7
sexual intercourse due to an individual's age when the individual and the individual’s partner have 8
the necessary gametes to establish pregnancy; 9
(iv) An individual’s inability to achieve pregnancy as an individual or with a partner 10
because the individual or the individual and the individual’s partner do not have the necessary 11
gametes to achieve a pregnancy; 12
(v) An individual’s increased risk, independently or with the individual’s partner, of 13
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or 14
(vi) As defined by the American Society of Reproductive Medicine, its successor 15
organization, or comparable organization. Pregnancy resulting in a loss does not cause the time 16
period of trying to establish a pregnancy to be restarted. 17
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard 18
fertility-preservation services" means procedures consistent with established medical practices and 19
professional guidelines published by the American Society for Reproductive Medicine, the 20
American Society of Clinical Oncology, or other reputable professional medical organizations, its 21
successor organization, or a comparable organization, for an individual who has a medical or 22
genetic condition or who is expected to undergo treatment that has a possible side effect of or may 23
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the 24
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. 25
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 26
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 27
processes. 28
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 29
likely side effect of infertility as established by the American Society for Reproductive Medicine, 30
the American Society of Clinical Oncology, or other reputable professional organizations. 31
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 32
thousand dollars ($100,000). 33
(d) Coverage for the treatment of infertility under this section must be provided without 34
LC000882 - Page 6 of 13
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 1
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 2
or sexual orientation. 3
(e) Coverage for the treatment of infertility under this section must include: 4
(1) At least four complete oocyte retrievals with unlimited embryo transfers from those 5
oocyte retrievals or from any oocyte retrieval; 6
(2) The medical costs related to an embryo transfer to be made from or on behalf of an 7
insured to a third party; and 8
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo 9
will be transferred to a surrogate. 10
(f) An insurer described in subsection (a) of this section shall not impose any of the 11
following: 12
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 13
other limitations on coverage for the diagnosis and treatment of infertility, including the 14
prescription of fertility medications, different from those imposed on benefits for services not 15
related to infertility; 16
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 17
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 18
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 19
required benefits; 20
(3) Limitations on coverage based solely on arbitrary factors, including number of 21
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 22
on, a class protected under § 23-17-19.1, than that provided to other insureds; 23
(4) Impose any limitations on coverage required under this section based on an individual's 24
use of donor gametes, donor embryos or surrogacy; 25
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 26
are different from those impose on any other prescription medications; or 27
(6) Limitations under the policy based on anything other than the medical assessment of 28
an individual’s license healthcare provider. 29
(g) An insurer described in subsection (a) of this section shall provide coverage under this 30
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 31
insured’s healthcare provider determines that the treatment or procedures is likely to be 32
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. 33
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any 34
LC000882 - Page 7 of 13
clinical guidelines used for a policy subject to the requirements of this section must be based on 1
current guidelines developed by the American Society for Reproductive Medicine, its successor 2
organization, or a comparable organization such as the American Society of Clinical Oncology or 3
the American College of Obstetrics and Gynecology. 4
SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit 5
Medical Service Corporations" is hereby amended to read as follows: 6
27-20-20. Coverage for infertility. 7
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for 8
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 9
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 10
for the medically necessary expenses of diagnosis and treatment of infertility for women between 11
the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services 12
when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility 13
to a covered person. To the extent that a nonprofit medical service corporation provides 14
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 15
infertility, those tests and procedures shall not be excluded from reimbursement when provided 16
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 17
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 18
(20%), may be required for those programs and/or procedures the sole purpose of which is the 19
treatment of infertility. 20
(b) For purposes of this section, “infertility” means the condition of an otherwise 21
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 22
one year. 23
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 24
this section shall apply to blanket or group policies of insurance. 25
(c) For the purposes of this section, the following terms shall have the following meanings: 26
(1) “Infertility” means: 27
(i) The presence of a condition recognized by a healthcare provider as a cause of loss or 28
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 29
physical findings, diagnostic testing, or any combination of those factors; 30
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 31
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 32
partner have the necessary gametes to establish a pregnancy; 33
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected 34
LC000882 - Page 8 of 13
sexual intercourse due to an individual's age when the individual and the individual’s partner have 1
the necessary gametes to establish pregnancy; 2
(iv) An individual’s inability to achieve pregnancy as an individual or with a partner 3
because the individual or the individual and the individual’s partner do not have the necessary 4
gametes to achieve a pregnancy; 5
(v) An individual’s increased risk, independently or with the individual’s partner, of 6
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or 7
(vi) As defined by the American Society of Reproductive Medicine, its successor 8
organization, or comparable organization. Pregnancy resulting in a loss does not cause the time 9
period of trying to establish a pregnancy to be restarted. 10
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard 11
fertility-preservation services" means procedures consistent with established medical practices and 12
professional guidelines published by the American Society for Reproductive Medicine, the 13
American Society of Clinical Oncology, or other reputable professional medical organizations, its 14
successor organization, or a comparable organization, for an individual who has a medical or 15
genetic condition or who is expected to undergo treatment that has a possible side effect of or may 16
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the 17
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. 18
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 19
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 20
processes. 21
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 22
likely side effect of infertility as established by the American Society for Reproductive Medicine, 23
the American Society of Clinical Oncology, or other reputable professional organizations. 24
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 25
thousand dollars ($100,000). 26
(d) Coverage for the treatment of infertility under this section must be provided without 27
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 28
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 29
or sexual orientation. 30
(e) Coverage for the treatment of infertility under this section must include: 31
(1) At least four complete oocyte retrievals with unlimited embryo transfers from those 32
oocyte retrievals or from any oocyte retrieval; 33
(2) The medical costs related to an embryo transfer to be made from or on behalf of an 34
LC000882 - Page 9 of 13
insured to a third party; and 1
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo 2
will be transferred to a surrogate. 3
(f) An insurer described in subsection (a) of this section shall not impose any of the 4
following: 5
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 6
other limitations on coverage for the diagnosis and treatment of infertility, including the 7
prescription of fertility medications, different from those imposed on benefits for services not 8
related to infertility; 9
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 10
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 11
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 12
required benefits; 13
(3) Limitations on coverage based solely on arbitrary factors, including number of 14
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 15
on, a class protected under § 23-17-19.1, than that provided to other insureds; 16
(4) Impose any limitations on coverage required under this section based on an individual's 17
use of donor gametes, donor embryos or surrogacy; 18
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 19
are different from those impose on any other prescription medications; or 20
(6) Limitations under the policy based on anything other than the medical assessment of 21
an individual’s license healthcare provider. 22
(g) An insurer described in subsection (a) of this section shall provide coverage under this 23
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 24
insured’s healthcare provider determines that the treatment or procedures is likely to be 25
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. 26
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any 27
clinical guidelines used for a policy subject to the requirements of this section must be based on 28
current guidelines developed by the American Society for Reproductive Medicine, its successor 29
organization, or a comparable organization such as the American Society of Clinical Oncology or 30
the American College of Obstetrics and Gynecology. 31
SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health 32
Maintenance Organizations" is hereby amended to read as follows: 33
27-41-33. Coverage for infertility. 34
LC000882 - Page 10 of 13
(a) Any health maintenance organization service contract plan or policy delivered, issued 1
for delivery, or renewed in this state, except a contract providing supplemental coverage to 2
Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide 3
coverage for medically necessary expenses of diagnosis and treatment of infertility for women 4
between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation 5
services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 6
infertility to a covered person. To the extent that a health maintenance organization provides 7
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 8
infertility, those tests and procedures shall not be excluded from reimbursement when provided 9
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 10
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 11
(20%), may be required for those programs and/or procedures the sole purpose of which is the 12
treatment of infertility. 13
(b) For purposes of this section, “infertility” means the condition of an otherwise healthy 14
individual who is unable to conceive or sustain a pregnancy during a period of one year. 15
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 16
this section shall apply to blanket or group policies of insurance. 17
(c) For the purposes of this section, the following terms shall have the following meanings: 18
(i) (1) “Infertility” means: 19
(ii) The presence of a condition recognized by a healthcare provider as a cause of loss or 20
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 21
physical findings, diagnostic testing, or any combination of those factors; 22
(iii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 23
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 24
partner have the necessary gametes to establish a pregnancy; 25
(iv) An individual's inability to establish a pregnancy after six (6) months of unprotected 26
sexual intercourse due to an individual's age when the individual and the individual’s partner have 27
the necessary gametes to establish pregnancy; 28
(v) An individual’s inability to achieve pregnancy as an individual or with a partner 29
because the individual or the individual and the individual’s partner do not have the necessary 30
gametes to achieve a pregnancy; 31
(vi) An individual’s increased risk, independently or with the individual’s partner, of 32
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or 33
(vi) As defined by the American Society of Reproductive Medicine, its successor 34
LC000882 - Page 11 of 13
organization, or comparable organization. Pregnancy resulting in a loss does not cause the time 1
period of trying to establish a pregnancy to be restarted. 2
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard 3
fertility-preservation services" means procedures consistent with established medical practices and 4
professional guidelines published by the American Society for Reproductive Medicine, the 5
American Society of Clinical Oncology, or other reputable professional medical organizations, its 6
successor organization, or a comparable organization, for an individual who has a medical or 7
genetic condition or who is expected to undergo treatment that has a possible side effect of or may 8
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the 9
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material. 10
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 11
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 12
processes. 13
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 14
likely side effect of infertility as established by the American Society for Reproductive Medicine, 15
the American Society of Clinical Oncology, or other reputable professional organizations. 16
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 17
thousand dollars ($100,000). 18
(d) Coverage for the treatment of infertility under this section must be provided without 19
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 20
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 21
or sexual orientation. 22
(e) Coverage for the treatment of infertility under this section must include: 23
(1) At least four complete oocyte retrievals with unlimited embryo transfers from those 24
oocyte retrievals or from any oocyte retrieval; 25
(2) The medical costs related to an embryo transfer to be made from or on behalf of an 26
insured to a third party; and 27
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo 28
will be transferred to a surrogate. 29
(f) An insurer described in subsection (a) of this section shall not impose any of the 30
following: 31
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 32
other limitations on coverage for the diagnosis and treatment of infertility, including the 33
prescription of fertility medications, different from those imposed on benefits for services not 34
LC000882 - Page 12 of 13
related to infertility; 1
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 2
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 3
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 4
required benefits; 5
(3) Limitations on coverage based solely on arbitrary factors, including number of 6
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 7
on, a class protected under § 23-17-19.1, than that provided to other insureds; 8
(4) Impose any limitations on coverage required under this section based on an individual's 9
use of donor gametes, donor embryos or surrogacy; 10
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 11
are different from those impose on any other prescription medications; or 12
(6) Limitations under the policy based on anything other than the medical assessment of 13
an individual’s license healthcare provider. 14
(g) An insurer described in subsection (a) of this section shall provide coverage under this 15
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 16
insured’s healthcare provider determines that the treatment or procedures is likely to be 17
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos. 18
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any 19
clinical guidelines used for a policy subject to the requirements of this section must be based on 20
current guidelines developed by the American Society for Reproductive Medicine, its successor 21
organization, or a comparable organization such as the American Society of Clinical Oncology or 22
the American College of Obstetrics and Gynecology. 23
SECTION 5. This act shall take effect on January 1, 2026. 24
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LC000882
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND INSURANCE POLICIES
***
This act would amend the current law on health insurance coverage for fertility diagnostic 1
care, standard fertility preservation services, and fertility treatment and would require coverage for 2
any medically necessary ovulation-enhancing drugs and medical services related to prescribing and 3
monitoring the use of ovulation-enhancing drugs that is intended to treat infertility and establish a 4
pregnancy that results in a live birth. 5
This act would take effect on January 1, 2026. 6
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LC000882
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