2025 -- S 0691
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LC001630
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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 SICKNESS INSURANCE POLICIES
Introduced By: Senators Mack, Valverde, Urso, Murray, Lauria, Ujifusa, Kallman, Euer,
DiMario, and Bissaillon
Date Introduced: March 07, 2025
Referred To: Senate 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
(1) The presence of a condition recognized by a healthcare provider as a cause of loss or 19
LC001630 - Page 2 of 13
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 1
physical findings, diagnostic testing, or any combination of those factors; 2
(2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 3
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 4
partner have the necessary gametes to achieve pregnancy; 5
(3) An individual’s inability to establish pregnancy after six (6) months of unprotected 6
sexual intercourse due to the individual’s age when the individual and the individual’s partner have 7
the necessary gametes to achieve pregnancy; 8
(4) An individual’s inability to achieve pregnancy as an individual or with a partner 9
because the individual or the individual and the individual’s partner do not have the necessary 10
gametes to achieve a pregnancy; 11
(5) An individual’s increased risk, independently or with the individual’s partner, of 12
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and 13
(6) Infertility as defined by the American Society of Reproductive Medicine, its successor 14
organization, or a comparable organization. 15
(c) For purposes of this section, “standard fertility-preservation services” means 16
procedures consistent with established medical practices and professional guidelines published by 17
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 18
other reputable professional medical organizations, its successor organization, or a comparable 19
organization, for an individual who has a medical or genetic condition or who is expected to 20
undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of 21
impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and 22
storage of gametes, embryos, and reproductive material. 23
(d) For purposes of this section, pregnancy resulting in a loss does not cause the time period 24
of trying to achieve a pregnancy to be restarted. 25
(e) Coverage for the treatment of infertility under this section shall be provided without 26
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 27
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 28
or sexual orientation. 29
(f) Coverage for the treatment of infertility under this section shall: 30
(1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers 31
from those oocyte retrievals or from any oocyte retrieval; 32
(2) Include the medical costs related to an embryo transfer to be made from or on behalf of 33
an insured to a third party; and 34
LC001630 - Page 3 of 13
(3) Be provided regardless of whether donor gametes or embryos are used or if an embryo 1
will be transferred to a surrogate. 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)(g) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, 9
this section shall apply to blanket or group policies of insurance. 10
(g) The health insurance contract may limit coverage to a lifetime cap of one hundred 11
thousand dollars ($100,000). 12
(h) An insurer described in subsection (a) of this section shall not impose any of the 13
following: 14
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 15
other limitations on coverage for the diagnosis and treatment of infertility, including the 16
prescription of fertility medications, different from those imposed on benefits for services not 17
related to infertility. 18
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 19
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 20
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 21
required benefits. 22
(3) Limitations on coverage based solely on arbitrary factors, including number of 23
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 24
upon a class protected under § 23-17-19.1 than other insureds. 25
(4) Limitations on coverage required under this section based on an individual's use of 26
donor gametes, donor embryos or surrogacy. 27
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 28
are different from those imposed on any other prescription medications. 29
(6) Limitations under the policy based on anything other than the medical assessment of 30
an individual’s licensed healthcare provider. 31
(i) An insurer described in subsection (a) of this section shall provide coverage under this 32
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 33
insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful 34
LC001630 - Page 4 of 13
or the insured seeks to use previously retrieved oocytes or embryos. 1
(j) This section shall not interfere with the clinical judgment of a healthcare provider. Any 2
clinical guidelines used for a policy subject to the requirements of this section shall be based on 3
current guidelines developed by the American Society for Reproductive Medicine, its successor 4
organization, or a comparable organization such as the American Society of Clinical Oncology or 5
the American College of Obstetrics and Gynecology. 6
SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit 7
Hospital Service Corporations" is hereby amended to read as follows: 8
27-19-23. Coverage for infertility. 9
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for 10
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 11
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 12
for medically necessary expenses of diagnosis and treatment of infertility for women between the 13
ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services 14
when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility 15
to a covered person. To the extent that a nonprofit hospital service corporation provides 16
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 17
infertility, those tests and procedures shall not be excluded from reimbursement when provided 18
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 19
(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent 20
(20%), may be required for those programs and/or procedures the sole purpose of which is the 21
treatment of infertility. 22
(b) For purposes of this section, “infertility” means: the condition of an otherwise 23
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 24
one year. 25
(1) The presence of a condition recognized by a healthcare provider as a cause of loss or 26
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 27
physical findings, diagnostic testing, or any combination of those factors; 28
(2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 29
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 30
partner have the necessary gametes to achieve pregnancy; 31
(3) An individual’s inability to establish pregnancy after six (6) months of unprotected 32
sexual intercourse due to the individual’s age when the individual and the individual’s partner have 33
the necessary gametes to achieve pregnancy; 34
LC001630 - Page 5 of 13
(4) An individual’s inability to achieve pregnancy as an individual or with a partner 1
because the individual or the individual and the individual’s partner do not have the necessary 2
gametes to achieve a pregnancy; 3
(5) An individual’s increased risk, independently or with the individual’s partner, of 4
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and 5
(6) Infertility as defined by the American Society of Reproductive Medicine, its successor 6
organization, or a comparable organization. 7
(c) For purposes of this section, “standard fertility-preservation services” means 8
procedures consistent with established medical practices and professional guidelines published by 9
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 10
other reputable professional medical organizations, its successor organization, or a comparable 11
organization, for an individual who has a medical or genetic condition or who is expected to 12
undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of 13
impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and 14
storage of gametes, embryos, and reproductive material. 15
(d) For purposes of this section, pregnancy resulting in a loss does not cause the time period 16
of trying to achieve a pregnancy to be restarted. 17
(e) Coverage for the treatment of infertility under this section shall be provided without 18
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 19
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 20
or sexual orientation. 21
(f) Coverage for the treatment of infertility under this section shall: 22
(1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers 23
from those oocyte retrievals or from any oocyte retrieval; 24
(2) Include the medical costs related to an embryo transfer to be made from or on behalf of 25
an insured to a third party; and 26
(3) Be provided regardless of whether donor gametes or embryos are used or if an embryo 27
will be transferred to a surrogate. 28
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 29
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 30
processes. 31
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 32
likely side effect of infertility as established by the American Society for Reproductive Medicine, 33
the American Society of Clinical Oncology, or other reputable professional organizations. 34
LC001630 - Page 6 of 13
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 1
thousand dollars ($100,000). 2
(g) An insurer described in subsection (a) of this section shall not impose any of the 3
following: 4
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 5
other limitations on coverage for the diagnosis and treatment of infertility, including the 6
prescription of fertility medications, different from those imposed on benefits for services not 7
related to infertility. 8
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 9
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 10
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 11
required benefits. 12
(3) Limitations on coverage based solely on arbitrary factors, including number of 13
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 14
upon a class protected under § 23-17-19.1 than other insureds. 15
(4) Limitations on coverage required under this section based on an individual's use of 16
donor gametes, donor embryos or surrogacy. 17
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 18
are different from those imposed on any other prescription medications. 19
(6) Limitations under the policy based on anything other than the medical assessment of 20
an individual’s licensed healthcare provider. 21
(h) An insurer described in subsection (a) of this section shall provide coverage under this 22
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 23
insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful 24
or the insured seeks to use previously retrieved oocytes or embryos. 25
(i) This section shall not interfere with the clinical judgment of a healthcare provider. Any 26
clinical guidelines used for a policy subject to the requirements of this section shall be based on 27
current guidelines developed by the American Society for Reproductive Medicine, its successor 28
organization, or a comparable organization such as the American Society of Clinical Oncology or 29
the American College of Obstetrics and Gynecology. 30
SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit 31
Medical Service Corporations" is hereby amended to read as follows: 32
27-20-20. Coverage for infertility. 33
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for 34
LC001630 - Page 7 of 13
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare 1
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage 2
for the medically necessary expenses of diagnosis and treatment of infertility for women between 3
the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services 4
when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility 5
to a covered person. To the extent that a nonprofit medical service corporation provides 6
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 7
infertility, those tests and procedures shall not be excluded from reimbursement when provided 8
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 9
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 10
(20%), may be required for those programs and/or procedures the sole purpose of which is the 11
treatment of infertility. 12
(b) For purposes of this section, “infertility” means: the condition of an otherwise 13
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of 14
one year. 15
(1) The presence of a condition recognized by a healthcare provider as a cause of loss or 16
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 17
physical findings, diagnostic testing, or any combination of those factors; 18
(2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 19
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 20
partner have the necessary gametes to achieve pregnancy; 21
(3) An individual’s inability to establish pregnancy after six (6) months of unprotected 22
sexual intercourse due to the individual’s age when the individual and the individual’s partner have 23
the necessary gametes to achieve pregnancy; 24
(4) An individual’s inability to achieve pregnancy as an individual or with a partner 25
because the individual or the individual and the individual’s partner do not have the necessary 26
gametes to achieve a pregnancy; 27
(5) An individual’s increased risk, independently or with the individual’s partner, of 28
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and 29
(6) Infertility as defined by the American Society of Reproductive Medicine, its successor 30
organization, or a comparable organization. 31
(c) For purposes of this section, “standard fertility-preservation services” means 32
procedures consistent with established medical practices and professional guidelines published by 33
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 34
LC001630 - Page 8 of 13
other reputable professional medical organizations, its successor organization, or a comparable 1
organization, for an individual who has a medical or genetic condition or who is expected to 2
undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of 3
impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and 4
storage of gametes, embryos, and reproductive material. 5
(d) For purposes of this section, pregnancy resulting in a loss does not cause the time period 6
of trying to achieve a pregnancy to be restarted. 7
(e) Coverage for the treatment of infertility under this section shall be provided without 8
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 9
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 10
or sexual orientation. 11
(f) Coverage for the treatment of infertility under this section shall: 12
(1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers 13
from those oocyte retrievals or from any oocyte retrieval; 14
(2) Include the medical costs related to an embryo transfer to be made from or on behalf of 15
an insured to a third party; and 16
(3) Be provided regardless of whether donor gametes or embryos are used or if an embryo 17
will be transferred to a surrogate. 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
(g) An insurer described in subsection (a) of this section shall not impose any of the 27
following: 28
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 29
other limitations on coverage for the diagnosis and treatment of infertility, including the 30
prescription of fertility medications, different from those imposed on benefits for services not 31
related to infertility. 32
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 33
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 34
LC001630 - Page 9 of 13
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 1
required benefits. 2
(3) Limitations on coverage based solely on arbitrary factors, including number of 3
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 4
upon a class protected under § 23-17-19.1 than other insureds. 5
(4) Limitations on coverage required under this section based on an individual's use of 6
donor gametes, donor embryos or surrogacy. 7
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 8
are different from those imposed on any other prescription medications. 9
(6) Limitations under the policy based on anything other than the medical assessment of 10
an individual’s licensed healthcare provider. 11
(h) An insurer described in subsection (a) of this section shall provide coverage under this 12
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 13
insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful 14
or the insured seeks to use previously retrieved oocytes or embryos. 15
(i) This section shall not interfere with the clinical judgment of a healthcare provider. Any 16
clinical guidelines used for a policy subject to the requirements of this section shall be based on 17
current guidelines developed by the American Society for Reproductive Medicine, its successor 18
organization, or a comparable organization such as the American Society of Clinical Oncology or 19
the American College of Obstetrics and Gynecology. 20
SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health 21
Maintenance Organizations" is hereby amended to read as follows: 22
27-41-33. Coverage for infertility. 23
(a) Any health maintenance organization service contract plan or policy delivered, issued 24
for delivery, or renewed in this state, except a contract providing supplemental coverage to 25
Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide 26
coverage for medically necessary expenses of diagnosis and treatment of infertility for women 27
between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation 28
services when a medically necessary medical treatment may directly or indirectly cause iatrogenic 29
infertility to a covered person. To the extent that a health maintenance organization provides 30
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than 31
infertility, those tests and procedures shall not be excluded from reimbursement when provided 32
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five 33
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent 34
LC001630 - Page 10 of 13
(20%), may be required for those programs and/or procedures the sole purpose of which is the 1
treatment of infertility. 2
(b) For purposes of this section, “infertility” means: the condition of an otherwise healthy 3
individual who is unable to conceive or sustain a pregnancy during a period of one year. 4
(1) The presence of a condition recognized by a healthcare provider as a cause of loss or 5
impairment of fertility, based on an individual’s medical, sexual, and reproductive history, age, 6
physical findings, diagnostic testing, or any combination of those factors; 7
(2) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth 8
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s 9
partner have the necessary gametes to achieve pregnancy; 10
(3) An individual’s inability to establish pregnancy after six (6) months of unprotected 11
sexual intercourse due to the individual’s age when the individual and the individual’s partner have 12
the necessary gametes to achieve pregnancy; 13
(4) An individual’s inability to achieve pregnancy as an individual or with a partner 14
because the individual or the individual and the individual’s partner do not have the necessary 15
gametes to achieve a pregnancy; 16
(5) An individual’s increased risk, independently or with the individual’s partner, of 17
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; and 18
(6) Infertility as defined by the American Society of Reproductive Medicine, its successor 19
organization, or a comparable organization. 20
(c) For purposes of this section, “standard fertility-preservation services” means 21
procedures consistent with established medical practices and professional guidelines published by 22
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 23
other reputable professional medical organizations, its successor organization, or a comparable 24
organization, for an individual who has a medical or genetic condition or who is expected to 25
undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of 26
impairment of fertility and includes, but is not limited to, the procurement, cryopreservation, and 27
storage of gametes, embryos, and reproductive material. 28
(d) For purposes of this section, pregnancy resulting in a loss does not cause the time period 29
of trying to achieve a pregnancy to be restarted. 30
(e) Coverage for the treatment of infertility under this section shall be provided without 31
discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender 32
expression, gender identity, genetic information, marital status, national origin, race, religion, sex, 33
or sexual orientation. 34
LC001630 - Page 11 of 13
(f) Coverage for the treatment of infertility under this section shall: 1
(1) Include at least four (4) complete oocyte retrievals with unlimited embryo transfers 2
from those oocyte retrievals or from any oocyte retrieval; 3
(2) Include the medical costs related to an embryo transfer to be made from or on behalf of 4
an insured to a third party; and 5
(3) Be provided regardless of whether donor gametes or embryos are used or if an embryo 6
will be transferred to a surrogate. 7
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by 8
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or 9
processes. 10
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a 11
likely side effect of infertility as established by the American Society for Reproductive Medicine, 12
the American Society of Clinical Oncology, or other reputable professional organizations. 13
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred 14
thousand dollars ($100,000). 15
(g) An insurer described in subsection (a) of this section shall not impose any of the 16
following: 17
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any 18
other limitations on coverage for the diagnosis and treatment of infertility, including the 19
prescription of fertility medications, different from those imposed on benefits for services not 20
related to infertility. 21
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage 22
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of 23
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for 24
required benefits. 25
(3) Limitations on coverage based solely on arbitrary factors, including number of 26
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements 27
upon a class protected under § 23-17-19.1 than other insureds. 28
(4) Limitations on coverage required under this section based on an individual's use of 29
donor gametes, donor embryos or surrogacy. 30
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that 31
are different from those imposed on any other prescription medications. 32
(6) Limitations under the policy based on anything other than the medical assessment of 33
an individual’s licensed healthcare provider. 34
LC001630 - Page 12 of 13
(h) An insurer described in subsection (a) of this section shall provide coverage under this 1
section regardless of whether the insured foregoes a particular fertility treatment or procedure if the 2
insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful 3
or the insured seeks to use previously retrieved oocytes or embryos. 4
(i) This section shall not interfere with the clinical judgment of a healthcare provider. Any 5
clinical guidelines used for a policy subject to the requirements of this section shall be based on 6
current guidelines developed by the American Society for Reproductive Medicine, its successor 7
organization, or a comparable organization such as the American Society of Clinical Oncology or 8
the American College of Obstetrics and Gynecology. 9
SECTION 5. This act shall apply to health plans that are entered into, amended, extended, 10
or renewed on or after January 1, 2026. 11
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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 require individual and group health insurance policies that provide 1
pregnancy-related benefits to cover medically necessary expenses for diagnosis and treatment of 2
infertility and standard fertility-preservation services regardless of the insured’s age. This act would 3
also change the definitions of infertility and standard fertility-preservation services as they 4
currently exist in chapters 27-18, 27-19, 27-20 and 27-41. The act would further remove the one 5
hundred thousand dollar ($100,000) lifetime cap on coverage for these services. 6
This act would apply to health plans that are entered into, amended, extended, or renewed 7
on or after January 1, 2026. 8
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