[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 874 Introduced in Senate (IS)]







107th CONGRESS
  1st Session
                                 S. 874

To require health plans to include infertility benefits, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 14, 2001

Mr. Torricelli introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To require health plans to include infertility benefits, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Fair Access to Infertility Treatment 
and Hope Act of 2001''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) infertility affects 6,100,000 men and women;
            (2) infertility is a disease which affects men and women 
        with equal frequency;
            (3) approximately 1 in 10 couples cannot conceive without 
        medical assistance;
            (4) recent medical breakthroughs make infertility a 
        treatable disease; and
            (5) only 25 percent of all health plan sponsors provide 
        coverage for infertility services.

SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.) is amended by adding at the end the following:

``SEC. 714. REQUIRED COVERAGE FOR INFERTILITY BENEFITS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, shall ensure that coverage is provided for infertility 
benefits.
    ``(b) Infertility Benefits.--In subsection (a), the term 
`infertility benefits' at a minimum includes--
            ``(1) diagnostic testing and treatment of infertility;
            ``(2) drug therapy, artificial insemination, and low tubal 
        ovum transfers;
            ``(3) in vitro fertilization, intra-cytoplasmic sperm 
        injection, gamete donation, embryo donation, assisted hatching, 
        embryo transfer, gamete intra-fallopian tube transfer, zygote 
        intra-fallopian tube transfer; and
            ``(4) any other medically indicated nonexperimental 
        services or procedures that are used to treat infertility or 
        induce pregnancy.
    ``(c) In Vitro Fertilization.--
            ``(1) Limitation.--
                    ``(A) In general.--Subject to subparagraph (B), 
                coverage of procedures under subsection (b)(3) may be 
                limited to 4 completed embryo transfers.
                    ``(B) Additional transfers.--If a live birth 
                follows a completed embryo transfer under a procedure 
                described in subparagraph (A), not less than 2 
                additional completed embryo transfers shall be 
                provided.
            ``(2) Requirement.--Coverage of procedures under subsection 
        (b)(3) shall be provided if--
                    ``(A) the individual has been unable to attain or 
                sustain a successful pregnancy through reasonable, less 
                costly medically appropriate covered infertility 
                treatments; and
                    ``(B) the procedures are performed at medical 
                facilities that conform with the minimal guidelines and 
                standards for assisted reproductive technology of the 
                American College of Obstetric and Gynecology or the 
                American Society for Reproductive Medicine.
    ``(d) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan because of the individual's or enrollee's use or 
        potential use of items or services that are covered in 
        accordance with the requirements of this section;
            ``(2) provide monetary payments or rebates to a covered 
        individual to encourage such individual to accept less than the 
        minimum protections available under this section; or
            ``(3) provide incentives (monetary or otherwise) to a 
        health care professional to induce such professional to 
        withhold from a covered individual services described in 
        subsection (a).
    ``(e) Rules of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as preventing a group health plan and a 
                health insurance issuer providing health insurance 
                coverage in connection with a group health plan from 
                imposing deductibles, coinsurance, or other cost-
                sharing or limitations in relation to benefits for 
                services described in this section under the plan, 
                except that such a deductible, coinsurance, or other 
                cost-sharing or limitation for any such service may not 
                be greater than such a deductible, coinsurance, or 
                cost-sharing or limitation for any similar service 
                otherwise covered under the plan;
                    ``(B) as requiring a group health plan and a health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational treatments of services 
                described in this section, except to the extent that 
                the plan or issuer provides coverage for other 
                experimental or investigational treatments or services.
            ``(2) Limitations.--As used in paragraph (1), the term 
        `limitation' includes restricting the type of health care 
professionals that may provide such treatments or services.
    ``(f) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan, 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) 
is amended by inserting after the item relating to section 713 the 
following new item:

``Sec. 714. Required coverage for infertility benefits for federal 
                            employees health benefits plans.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2002.

SEC. 4. PUBLIC HEALTH SERVICE ACT.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at 
the end the following:

``SEC. 2707. REQUIRED COVERAGE FOR INFERTILITY BENEFITS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, shall ensure that coverage is provided for infertility 
benefits.
    ``(b) Infertility Benefits.--In subsection (a), the term 
`infertility benefits' at a minimum includes--
            ``(1) diagnostic testing and treatment of infertility;
            ``(2) drug therapy, artificial insemination, and low tubal 
        ovum transfers;
            ``(3) in vitro fertilization, intra-cytoplasmic sperm 
        injection, gamete donation, embryo donation, assisted hatching, 
        embryo transfer, gamete intra-fallopian tube transfer, zygote 
        intra-fallopian tube transfer; and
            ``(4) any other medically indicated nonexperimental 
        services or procedures that are used to treat infertility or 
        induce pregnancy.
    ``(c) In Vitro Fertilization.--
            ``(1) Limitation.--
                    ``(A) In general.--Subject to subparagraph (B), 
                coverage of procedures under subsection (b)(3) may be 
                limited to 4 completed embryo transfers.
                    ``(B) Additional transfers.--If a live birth 
                follows a completed embryo transfer under a procedure 
                described in subparagraph (A), not less than 2 
                additional completed embryo transfers shall be 
                provided.
            ``(2) Requirement.--Coverage of procedures under subsection 
        (b)(3) shall be provided if--
                    ``(A) the individual has been unable to attain or 
                sustain a successful pregnancy through reasonable, less 
                costly medically appropriate covered infertility 
                treatments; and
                    ``(B) the procedures are performed at medical 
                facilities that conform with the minimal guidelines and 
                standards for assisted reproductive technology of the 
                American College of Obstetric and Gynecology or the 
                American Society for Reproductive Medicine.
    ``(d) Prohibitions.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not--
            ``(1) deny to an individual eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan because of the individual's or enrollee's use or 
        potential use of items or services that are covered in 
        accordance with the requirements of this section;
            ``(2) provide monetary payments or rebates to a covered 
        individual to encourage such individual to accept less than the 
        minimum protections available under this section; or
            ``(3) provide incentives (monetary or otherwise) to a 
        health care professional to induce such professional to 
        withhold from a covered individual services described in 
        subsection (a).
    ``(e) Rules of Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as preventing a group health plan and a 
                health insurance issuer providing health insurance 
                coverage in connection with a group health plan from 
                imposing deductibles, coinsurance, or other cost-
                sharing or limitations in relation to benefits for 
                services described in this section under the plan, 
                except that such a deductible, coinsurance, or other 
                cost-sharing or limitation for any such service may not 
                be greater than such a deductible, coinsurance, or 
                cost-sharing or limitation for any similar service 
otherwise covered under the plan;
                    ``(B) as requiring a group health plan and a health 
                insurance issuer providing health insurance coverage in 
                connection with a group health plan to cover 
                experimental or investigational treatments of services 
                described in this section, except to the extent that 
                the plan or issuer provides coverage for other 
                experimental or investigational treatments or services.
            ``(2) Limitations.--As used in paragraph (1), the term 
        `limitation' includes restricting the type of health care 
        professionals that may provide such treatments or services.
    ``(f) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan, 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.''.
    (b) Individual Market.--Part B of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg-41 et seq.) is amended--
            (1) by redesignating the first subpart 3 (relating to other 
        requirements) as subpart 2; and
            (2) by adding at the end of subpart 2 the following new 
        section:

``SEC. 2753. REQUIRED COVERAGE FOR INFERTILITY BENEFITS.

    ``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.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated on or after January 1, 2002.

SEC. 5. REQUIRED COVERAGE FOR INFERTILITY BENEFITS FOR FEDERAL 
              EMPLOYEES HEALTH BENEFITS PLANS.

    (a) Types of Benefits.--Section 8904(a)(1) of title 5, United 
States Code, is amended by adding at the end the following:
                    ``(G) Infertility benefits.''.
    (b) Health Benefits Plan Contract Requirement.--Section 8902 of 
title 5, United States Code, is amended by adding at the end the 
following:
    ``(p)(1) Each contract under this chapter shall include a provision 
that ensures infertility benefits as provided under this subsection.
    ``(2) Infertility benefits under this subsection shall include--
            ``(A) diagnostic testing and treatment of infertility;
            ``(B) drug therapy, artificial insemination, and low tubal 
        ovum transfers;
            ``(C) in vitro fertilization, intra-cytoplasmic sperm 
        injection, gamete donation, embryo donation, assisted hatching, 
        embryo transfer, gamete intra-fallopian tube transfer, zygote 
        intra-fallopian tube transfer; and
            ``(D) any other medically indicated nonexperimental 
        services or procedures that are used to treat infertility or 
        induce pregnancy.
    ``(3)(A)(i) Subject to clause (ii), procedures under paragraph 
(2)(C) shall be limited to 4 completed embryo transfers.
    ``(ii) If a live birth follows a completed embryo transfer, 2 
additional completed embryo transfers shall be provided.
    ``(B) Procedures under paragraph (2)(C) shall be provided if--
            ``(i) the individual has been unable to attain or sustain a 
        successful pregnancy through reasonable, less costly medically 
        appropriate covered infertility treatments; and
            ``(ii) the procedures are performed at medical facilities 
        that conform with the minimal guidelines and standards for 
        assisted reproductive technology of the American College of 
        Obstetric and Gynecology or the American Society for 
        Reproductive Medicine.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to contract years beginning on or after January 1, 2002.
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