[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3026 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 3026

 To amend chapter 89 of title 5, United States Code, and chapter 55 of 
title 10, United States Code, to provide that any health benefits plan 
 which provides obstetrical benefits shall be required also to provide 
        coverage for the diagnosis and treatment of infertility.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 5, 2003

Mr. Meehan (for himself and Mr. Weiner) introduced the following bill; 
   which was referred to the Committee on Government Reform, and in 
    addition to the Committee on Armed Services, 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 chapter 89 of title 5, United States Code, and chapter 55 of 
title 10, United States Code, to provide that any health benefits plan 
 which provides obstetrical benefits shall be required also to provide 
        coverage for the diagnosis and treatment of infertility.

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

SECTION 1. INFERTILITY BENEFITS.

    (a) Federal Employee Health Benefits Plans.--Section 8904 of title 
5, United States Code, is amended by adding at the end the following:
    ``(c)(1) Each health benefits plan described by section 8903 or 
8903a which provides obstetrical benefits shall also provide coverage 
for the diagnosis and treatment of infertility, including 
nonexperimental assisted reproductive technology procedures.
    ``(2) Under this subsection--
            ``(A) coverage for the diagnosis or treatment of 
        infertility may not be subject to any copayment or deductible 
        greater than applies with respect to obstetrical benefits under 
        the plan involved; and
            ``(B) coverage for a procedure described in paragraph 
        (5)(B) shall, in the case of any individual, be required only 
        if--
                    ``(i) such individual has been unable to carry a 
                pregnancy to live birth through less costly, medically 
                appropriate infertility treatments for which such 
                individual has coverage under this chapter;
                    ``(ii) the procedure (including any retrieval 
                incident thereto) is performed at medical facilities 
                that conform to the standards of the American Society 
                for Reproductive Medicine, the Society for Assisted 
                Reproductive Technology, the American College of 
                Obstetricians and Gynecologists, or any other similar 
                nationally-recognized organization, or a Federal agency 
                that promulgates standards for infertility procedures; 
                and
                    ``(iii) if the services of a laboratory are 
                required, such laboratory is accredited by the College 
                of American Pathologists' Reproductive Laboratory 
                Accreditation Program or any other similar nationally-
                recognized program, or a Federal agency performing a 
                similar function.
    ``(3)(A) Except as provided in subparagraph (B) or (C)--
            ``(i) coverage for a procedure described in paragraph 
        (5)(B) may be provided only if the individual involved has not 
        already undergone 4 attempts to achieve a live birth using any 
        such procedures; and
            ``(ii) coverage for an oocyte retrieval may be provided 
        only if the individual involved has not already undergone 4 
        complete oocyte retrievals.
    ``(B) For purposes of clause (i) of subparagraph (A)--
            ``(i) if a live birth results from the third attempt (using 
        a procedure described in paragraph (5)(B)), such clause shall 
        be applied by substituting `5' for `4'; and
            ``(ii) if a live birth results from the fourth attempt 
        (using a procedure described in paragraph (5)(B)), such clause 
        shall be applied by substituting `6' for the otherwise 
        applicable lifetime maximum.
    ``(C) For purposes of clause (ii) of subparagraph (A)--
            ``(i) if a live birth results from the third oocyte 
        retrieval, such clause shall be applied by substituting `5' for 
        `4'; and
            ``(ii) if a live birth results from the fourth oocyte 
        retrieval, such clause shall be applied by substituting `6' for 
        the otherwise applicable lifetime maximum.
    ``(4) In no event shall this subsection be considered to permit or 
require coverage--
            ``(A) if, or to the extent that, the health benefits plan 
        objects to such coverage on the basis of religious beliefs; or
            ``(B) in connection with any procedure or treatment, unless 
        rendered by a physician or at the direction or request of a 
        physician.
    ``(5) For purposes of this subsection--
            ``(A) the term `infertility' means--
                    ``(i) the inability to conceive a pregnancy after 
                12 months of regular sexual relations without 
contraception or to carry a pregnancy to a live birth; or
                    ``(ii) the presence of a demonstrated condition 
                determined by 2 physicians (at least 1 of whom 
                specializes in infertility) to cause infertility; and
            ``(B) the term `nonexperimental assisted reproductive 
        technology procedure' means in vitro fertilization, gamete 
        intrafallopian transfer, zygote intrafallopian transfer, and 
        any other clinical treatment or procedure the safety and 
        efficacy of which are recognized by the American Society for 
        Reproductive Medicine, the American College of Obstetricians 
        and Gynecologists, or any other similar nationally-recognized 
        organization, or a Federal agency described in paragraph 
        (2)(B)(iii).
    ``(6) The Office shall prescribe any regulations necessary to carry 
out this subsection.''.
    (b) Defense Health Care Plans.--(1) Chapter 55 of title 10, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1110a. Obstetrical and infertility benefits
    ``(a)(1) Any health care plan under this chapter which provides 
obstetrical benefits shall also provide coverage for the diagnosis and 
treatment of infertility, including nonexperimental assisted 
reproductive technology procedures.
    ``(2) Under this subsection--
            ``(A) coverage for the diagnosis or treatment of 
        infertility may not be subject to any copayment or deductible 
        greater than applies with respect to obstetrical benefits under 
        the plan involved; and
            ``(B) coverage for a procedure described in paragraph 
        (5)(B) shall, in the case of any individual, be required only 
        if--
                    ``(i) such individual has been unable to carry a 
                pregnancy to live birth through less costly, medically 
                appropriate infertility treatments for which such 
                individual has coverage under this chapter;
                    ``(ii) the procedure (including any retrieval 
                incident thereto) is performed at medical facilities 
                that conform to the standards of the American Society 
                for Reproductive Medicine, the Society for Assisted 
                Reproductive Technology, the American College of 
                Obstetricians and Gynecologists, or any other similar 
                nationally-recognized organization, or a Federal agency 
                that promulgates standards for infertility procedures; 
                and
                    ``(iii) if the services of a laboratory are 
                required, such laboratory is accredited by the College 
                of American Pathologists' Reproductive Laboratory 
                Accreditation Program or any other similar nationally-
                recognized program, or a Federal agency performing a 
                similar function.
    ``(3)(A) Except as provided in subparagraph (B) or (C)--
            ``(i) coverage for a procedure described in paragraph 
        (5)(B) may be provided only if the individual involved has not 
        already undergone 4 attempts to achieve a live birth using any 
        such procedures; and
            ``(ii) coverage for an oocyte retrieval may be provided 
        only if the individual involved has not already undergone 4 
        complete oocyte retrievals.
    ``(B) For purposes of clause (i) of subparagraph (A)--
            ``(i) if a live birth results from the third attempt (using 
        a procedure described in paragraph (5)(B)), such clause shall 
        be applied by substituting `5' for `4'; and
            ``(ii) if a live birth results from the fourth attempt 
        (using a procedure described in paragraph (5)(B)), such clause 
        shall be applied by substituting `6' for the otherwise 
        applicable lifetime maximum.
    ``(C) For purposes of clause (ii) of subparagraph (A)--
            ``(i) if a live birth results from the third oocyte 
        retrieval, such clause shall be applied by substituting `5' for 
        `4'; and
            ``(ii) if a live birth results from the fourth oocyte 
        retrieval, such clause shall be applied by substituting `6' for 
        the otherwise applicable lifetime maximum.
    ``(4) In no event shall this subsection be considered to permit or 
require coverage--
            ``(A) if, or to the extent that, the health benefits plan 
        objects to such coverage on the basis of religious beliefs; or
            ``(B) in connection with any procedure or treatment, unless 
        rendered by a physician or at the direction or request of a 
        physician.
    ``(5) For purposes of this subsection--
            ``(A) the term `infertility' means--
                    ``(i) the inability to conceive a pregnancy after 
                12 months of regular sexual relations without 
                contraception or to carry a pregnancy to a live birth; 
                or
                    ``(ii) the presence of a demonstrated condition 
                determined by 2 physicians (at least 1 of whom 
                specializes in infertility) to cause infertility; and
            ``(B) the term `nonexperimental assisted reproductive 
        technology procedure' means in vitro fertilization, gamete 
        intrafallopian transfer, zygote intrafallopian transfer, and 
        any other clinical treatment or procedure the safety and 
        efficacy of which are recognized by the American Society for 
        Reproductive Medicine, the American College of Obstetricians 
        and Gynecologists, or any other similar nationally-recognized 
        organization, or a Federal agency described in paragraph 
        (2)(B)(iii).
    ``(b) The Secretary of Defense shall prescribe any regulations 
necessary to carry out this section.''.
    (2) The table of sections at the beginning of such chapter is 
amended by adding at the end the following new item:

``1110a. Obstetrical and infertility benefits.''.

SEC. 2. EFFECTIVE DATE.

    The amendments made by this Act shall apply with respect to 
contracts entered into or renewed for any year beginning after the end 
of the 6-month period beginning on the date of enactment of this Act.
                                 <all>