[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 389 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 389
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and chapter 89 of title 5, United States Code, to
require coverage for the treatment of infertility.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 31, 2001
Mr. Weiner (for himself, Mr. Bentsen, Mr. Andrews, Mr. Engel, Mr.
Frank, Mr. Gutierrez, Mr. Price of North Carolina, Ms. Woolsey, Mr.
Davis of Illinois, Ms. Eshoo, Mr. Frost, Mrs. Lowey, Mr. Meehan, Mr.
Sanders, and Mr. Wynn) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Education and the Workforce, and Government Reform,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of
the committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and chapter 89 of title 5, United States Code, to
require coverage for the treatment of infertility.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Family Building
Act of 2001''.
(b) Findings.--Congress makes the following findings:
(1) Infertility is a disease affecting more than 6,000,000
American women and men, about 10 percent of the reproductive
age population.
(2) Recent improvements in therapy make pregnancy possible
for more couples than in past years.
(3) The majority of group health plans do not provide
coverage for infertility therapy.
(4) A fundamental part of the human experience is
fulfilling the desire to reproduce.
SEC. 2. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF INFERTILITY.
(a) Group Health Plans.--
(1) Public health service act amendment.--(A) Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF
INFERTILITY.
``(a) Requirements for Coverage of Treatment of Infertility.--
``(1) In general.--In a case in which a group health plan,
and a health insurance issuer offering group health insurance
coverage provides coverage for obstetrical services, such plan
or issuer shall include (consistent with this section) coverage
for treatment of infertility.
``(2) Infertility defined.--For purposes of this section,
the term `infertility' means a disease or condition that
results in the abnormal function of the reproductive system,
which results in--
``(A) the inability to conceive after 1 year of
unprotected intercourse, or
``(B) the inability to carry a pregnancy to live
birth.
``(b) Required Coverage.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage shall
provide coverage for treatment of infertility deemed
appropriate by a participant or beneficiary and the treating
physician. Such treatment shall include ovulation induction,
artificial insemination, in vitro fertilization (IVF), gamete
intrafallopian transfer (GIFT), zygote intrafallopian transfer
(ZIFT), intracytoplasmic sperm injection (ICSI), and any other
treatment provided it has been deemed as `non-experimental' by
the Secretary of Health and Human Services after consultation
with appropriate professional and patient organizations such as
the American Society for Reproductive Medicine, RESOLVE, and
the American College of Obstetricians and Gynecologists.
``(2) Limitation on coverage of assisted reproductive
technology.--
``(A) In general.--In the case of assisted
reproductive technology, coverage shall be provided
if--
``(i) the participant or beneficiary has
been unable to bring a pregnancy to a live
birth through less costly medically appropriate
infertility treatments for which coverage is
available under the insured's policy, plan, or
contract;
``(ii) the participant or beneficiary has
not undergone 4 complete oocyte retrievals,
except that if a live birth follows a completed
oocyte retrieval, then at least 2 more
completed oocyte retrievals shall be covered,
with a lifetime cap of 6 retrievals;
``(iii) the treatment is performed at a
medical facility that--
``(I) conforms to the standards of
the American Society for Reproductive
Medicine; and
``(II) is in compliance with any
standards set by an appropriate Federal
agency.
``(B) Definition of assisted reproductive
technology.--For purposes of this paragraph, the term
`assisted reproductive technology' includes all
treatments or procedures that involve the handling of
human egg and sperm for the purpose of helping a woman
become pregnant. Types of Assisted Reproductive
Technology include in vitro fertilization, gamete
intrafallopian transfer, zygote intrafallopian
transfer, embryo cryopreservation, egg or embryo
donation, and surrogate birth.
``(3) Review by the secretary of health and human
services.--Not later than 5 years after the date of enactment
of the Family Building Act of 2001, the Secretary of Health and
Human Services, in consultation with the American Society for
Reproductive Medicine, RESOLVE, and the National Infertility
Association shall review the requirements for treatment of
infertility established under paragraphs (1) and (2).
``(c) Limitation.--Deductibles, coinsurance, and other cost-sharing
or other limitations for infertility therapy may not be imposed to the
extent they exceed the deductibles, coinsurance, and limitations that
are applied to similar services under the group health plan or health
insurance coverage.
``(d) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
``(1) deny to a participant or beneficiary eligibility, or
continued eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding the
requirements of this section;
``(2) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to be provided infertility treatments to which
they are entitled under this section or to providers to induce
such providers not to provide such treatments to qualified
participants or beneficiaries;
``(3) prohibit a provider from discussing with a
participant or beneficiary infertility treatment techniques or
medical treatment options relating to this section; or
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
infertility treatments to a qualified participant or beneficiary in
accordance with this section.
``(e) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo
infertility therapy.
``(f) Notice.--A group health plan under this part shall comply
with the notice requirement under section 713(b) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
``(g) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
``(h) Preemption.--The provisions of this section do not preempt
State law relating to health insurance coverage to the extent such
State law provides greater benefits with respect to infertility
treatments or prevention.''.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting ``sections
2704 and 2707''.
(2) ERISA amendment.--(A) Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF
INFERTILITY.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage in connection with such
a plan shall comply with the requirements of section 2707 of the Public
Health Service Act, and such requirements shall be deemed to be
incorporated into this subsection.
``(b) Notice.--A health insurance issuer offering health insurance
coverage in connection with a group health plan shall comply with the
notice requirement under section 713(b) with respect to the
requirements referred to in subsection (a) as if such section applied
to such issuer and such issuer were a group health plan.''.
(B) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(C) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the
following new item:
``Sec. 714. Standards relating to benefits for treatment of
infertility.''.
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. STANDARD RELATING TO BENEFITS FOR TREATMENT OF
INFERTILITY.
``(a) In General.--The provisions of section 2707 shall apply to
health insurance coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to health insurance
coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
``(b) Notice.--A health insurance issuer under this part shall
comply with the notice requirement under section 713(b) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
referred to in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.''.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is
amended by striking ``section 2751'' and inserting ``sections 2751 and
2753''.
(c) Effective Dates.--
(1) Group health plans and group health insurance
coverage.--Subject to paragraph (3), the amendments made by
subsection (a) apply with respect to group health plans for
plan years beginning on or after January 1, 2002.
(2) Individual health insurance coverage.--The amendments
made by subsection (b) apply with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or operated
in the individual market on or after such date.
(3) Collective bargaining exception.--In the case of a
group health plan maintained pursuant to 1 or more collective
bargaining agreements between employee representatives and 1 or
more employers ratified before the date of enactment of this
Act, the amendments made by subsection (a) shall not apply to
plan years beginning before the later of--
(A) the date on which the last collective
bargaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act), or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amendment made
pursuant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any requirement
added by subsection (a) shall not be treated as a termination
of such collective bargaining agreement.
SEC. 3. AMENDMENT TO TITLE 5, UNITED STATES CODE.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following new subsection:
``(p)(1) Each contract under this chapter which provides
obstetrical benefits shall also provide (in a manner consistent with
section 2707 of the Public Health Service Act) coverage for the
diagnosis and treatment of infertility (as defined by such section).
``(2) Subsection (m)(1) shall not, with respect to any contract
under this chapter, prevent the inclusion of any terms which, under
paragraph (1), are required by reason of section 2707(h) of the Public
Health Service Act.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to contracts entered into or renewed for contract years
beginning at least 6 months after the date of enactment of this Act.
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