[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2960 Introduced in Senate (IS)]
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115th CONGRESS
2d Session
S. 2960
To require health insurance coverage for the treatment of infertility.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 24, 2018
Mr. Booker introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To require health insurance 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.
This Act may be cited as the ``Access to Infertility Treatment and
Care Act''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) Infertility is a medical disease recognized by the
World Health Organization, the American Society for
Reproductive Medicine, and the American Medical Association
that affects men and women equally.
(2) According to the Centers for Disease Control and
Prevention, 1 in 8 couples have difficulty getting pregnant or
sustaining a pregnancy.
(3) Infertility affects a broad spectrum of prospective
parents. No matter what race, religion, sexuality, or economic
status one is, infertility does not discriminate.
(4) Approximately one-third of infertility is attributed to
the female partner, one-third is attributed to the male
partner, and one-third is caused by a combination of problems
in both partners or is unexplained.
(5) Infertility disproportionately affects individuals with
particular health complications. For cancer patients and others
who must undergo treatments such as chemotherapy, radiation
therapy, hormone therapy, or surgery that are likely to harm
the reproductive system and organs, fertility preservation
becomes necessary.
(6) Leading causes of infertility include chronic
conditions and diseases of the endocrine or metabolic systems,
such as primary ovarian insufficiency, polycystic ovarian
syndrome, endometriosis, thyroid disorders, menstrual cycle
defects, autoimmune disorders, hormonal imbalances, testicular
disorders, and urological health issues. Other causes include
structural problems or blockages within the reproductive
system, exposure to infectious diseases, occupational or
environmental hazards, or genetic influences.
(7) Recent improvements in therapy and cryopreservation
make pregnancy possible for more people than in past years.
(8) Like all other diseases, infertility and its treatments
should be covered by health insurance.
(9) A 2017 national survey of employer-sponsored health
plans found that 44 percent of employers with at least 500
employees did not cover infertility services, and 25 percent of
companies with 20,000 or more employees did not cover
infertility services.
(10) States that do not require insurance coverage of
assisted reproductive technology have higher rates of multiple
births.
(11) The ability to have a family should not be denied to
anyone on account of a lack of insurance coverage for medically
necessary treatment.
SEC. 3. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF INFERTILITY AND
IATROGENIC INFERTILITY.
(a) In General.--Part A of title XXVII of the Public Health Service
Act (42 U.S.C. 300gg et seq.) is amended by inserting after section
2728 the following:
``SEC. 2729. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF
INFERTILITY AND IATROGENIC INFERTILITY.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall ensure
that such plan or coverage provides coverage for--
``(1) the treatment of infertility, including
nonexperimental assisted reproductive technology procedures, if
such plan or coverage provides coverage for obstetrical
services; and
``(2) the treatment of iatrogenic infertility.
``(b) Definitions.--In this section:
``(1) the term `assisted reproductive technology' means
treatments or procedures that involve the handling of human
egg, sperm, and embryo outside of the body with the intent of
facilitating a pregnancy, including in vitro fertilization, egg
or embryo cryopreservation, egg or embryo donation, and
gestational surrogacy;
``(2) the term `infertility' means a disease, defined by
the failure to achieve a successful pregnancy after 12 months
or more, or for women over age 35, 6 months or more, of
appropriate, timed unprotected intercourse or therapeutic donor
insemination; and
``(3) the term `iatrogenic infertility' means an impairment
of fertility due to surgery, radiation, chemotherapy, or other
medical treatment.
``(c) Required Coverage.--
``(1) Coverage for infertility.--Subject to paragraph (3),
a group health plan and a health insurance issuer offering
group or individual health insurance coverage that includes
coverage for obstetrical services shall provide coverage for
treatment of infertility determined appropriate by the treating
physician, including, as appropriate, ovulation induction, egg
retrieval, sperm retrieval, artificial insemination, in vitro
fertilization, genetic screening, intracytoplasmic sperm
injection, and any other nonexperimental treatment, as
determined by the Secretary in consultation with appropriate
professional and patient organizations such as the American
Society for Reproductive Medicine, RESOLVE: The National
Infertility Association, and the American College of
Obstetricians and Gynecologists.
``(2) Coverage for iatrogenic infertility.--A group health
plan and a health insurance issuer offering group or individual
health insurance coverage shall provide coverage for treatment
of fertility preservation services for individuals who undergo
medically necessary treatment that may cause iatrogenic
infertility, as determined by the treating physician, including
cryopreservation of gametes and other procedures, as determined
by the Secretary, consistent with established medical practices
and professional guidelines published by professional medical
organizations, including the American Society for Clinical
Oncology and the American Society for Reproductive Medicine.
``(3) Limitation on coverage of assisted reproductive
technology.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall
provide coverage for assisted reproductive technology as
required under paragraph (1) if--
``(A) the individual has been unable to bring a
pregnancy to a live birth through less costly
infertility treatments, as determined appropriate by
the treating physician, with consideration given to
participant's or beneficiary's specific diagnoses or
condition for which coverage is available under the
plan or coverage; and
``(B) the treatment is performed at a medical
facility that--
``(i) conforms to the standards of the
American Society for Reproductive Medicine and
the Society for Assisted Reproductive
Technology; and
``(ii) is in compliance with any standards
set by an appropriate Federal agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for infertility and iatrogenic
infertility therapy may not be imposed with respect to the services
required to be covered under subsection (c) to the extent that such
cost-sharing exceeds the cost-sharing applied to similar services under
the group health plan or health insurance coverage or such other
limitations are different from limitations imposed with respect to such
similar services.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to be provided infertility or iatrogenic
infertility treatments to which such participant or beneficiary
is entitled under this section or to providers to induce such
providers not to provide such treatments to qualified
participants or beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary infertility or iatrogenic
infertility treatment techniques or medical treatment options
relating to this section; or
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
infertility or iatrogenic infertility treatments to a qualified
participant or beneficiary in accordance with this section.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo
infertility or iatrogenic infertility therapy.
``(g) Notice.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall provide
notice to each participant and beneficiary under such plan regarding
the coverage required by this section in accordance with regulations
promulgated by the Secretary. Such notice shall be in writing and
prominently positioned in any literature or correspondence made
available or distributed by the plan or issuer and shall be
transmitted--
``(1) in the next mailing made by the plan or issuer to the
participant or beneficiary;
``(2) as part of any yearly informational packet sent to
the participant or beneficiary; or
``(3) not later than January 1, 2020,
whichever is earlier.
``(h) 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 or individual health insurance coverage from
negotiating the level and type of reimbursement with a provider for
care provided in accordance with this section.''.
(b) Conforming Amendment.--Section 2724(c) of the Public Health
Service Act (42 U.S.C. 300gg-23(c)) is amended by striking ``section
2704'' and inserting ``sections 2704 and 2708''.
(c) Effective Dates.--
(1) In general.--The amendments made by subsections (a) and
(b) shall apply for plan years beginning on or after the date
that is 6 months after the date of enactment of this Act.
(2) Collective bargaining exception.--
(A) In general.--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--
(i) 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
(ii) the date occurring 6 months after the
date of the enactment of this Act.
(B) Clarification.--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. 4. FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following:
``(p) Coverage for Diagnosis and Treatment of Infertility and
Iatrogenic Infertility.--
``(1) Definitions.--In this subsection, the terms
`infertility' and `iatrogenic infertility' have the meanings
given those terms in section 2729 of the Public Health Service
Act.
``(2) Required coverage.--A contract under this chapter
shall provide, in a manner consistent with section 2729 of the
Public Health Service Act--
``(A) coverage for the diagnosis and treatment of
infertility, including nonexperimental assisted
reproductive technology procedures, if such contract
covers obstetrical benefits; and
``(B) coverage for the diagnosis and treatment of
iatrogenic infertility.
``(3) Cost.--Coverage for the diagnosis or treatment of
infertility or iatrogenic infertility under a health benefits
plan described in section 8903 or 8903a may not be subject to
any copayment or deductible greater than the copayment or
deductible, respectively, applicable to obstetrical benefits
under the plan.
``(4) Preemption.--Subsection (m)(1) shall not, with
respect to a contract under this chapter, prevent the inclusion
of any terms that, under paragraph (2) of this subsection, are
required by reason of section 2729 of the Public Health Service
Act.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to any contract entered into or renewed for a
contract year beginning on or after the date that is 180 days after the
date of enactment of this Act, and any health benefits plan offered
under such a contract.
SEC. 5. BENEFITS FOR TREATMENT OF INFERTILITY AND IATROGENIC
INFERTILITY UNDER THE TRICARE PROGRAM.
(a) In General.--Chapter 55 of title 10, United States Code, is
amended by adding at the end the following new section:
``Sec. 1110c. Obstetrical and infertility benefits
``(a) In General.--Any health care plan under this chapter shall
provide, in a manner consistent with section 2729 of the Public Health
Service Act--
``(1) coverage for the diagnosis and treatment of
infertility, including nonexperimental assisted reproductive
technology procedures, if such plan covers obstetrical
benefits; and
``(2) coverage for the diagnosis and treatment of
iatrogenic infertility.
``(b) Copayment.--The Secretary of Defense shall establish cost-
sharing requirements for the coverage of diagnosis and treatment of
infertility and iatrogenic infertility described in subsection (a) that
are consistent with the cost-sharing requirements applicable to health
plans and health insurance coverage under section 2729(d) of the Public
Health Service Act.
``(c) Regulations.--The Secretary of Defense shall prescribe any
regulations necessary to carry out this section.
``(d) Definitions.--In this section, the terms `infertility' and
`iatrogenic infertility' have the meanings given those terms in section
2729 of the Public Health Service Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 55 of such title is amended by adding at the end the following
new item:
``1110c. Obstetrical and infertility benefits.''.
SEC. 6. TREATMENT OF INFERTILITY AND IATROGENIC INFERTILITY FOR
VETERANS AND SPOUSES OR PARTNERS OF VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720J. Infertility treatment for veterans and spouses or
partners of veterans.
``(a) In General.--The Secretary shall furnish treatment for
infertility and iatrogenic infertility, including through the use of
assisted reproductive technology, to a veteran or a spouse or partner
of a veteran if the veteran, and the spouse or partner of the veteran,
as applicable, apply jointly for such treatment and counseling through
a process prescribed by the Secretary for purposes of this section.
``(b) Infertility Defined.--In this section, the terms
`infertility' and `iatrogenic infertility' have the meanings given
those terms in section 2729 of the Public Health Service Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1720I the following new item:
``1720J. Infertility treatment for veterans and spouses or partners of
veterans.''.
(c) Regulations.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe regulations to carry out section 1720J of title 38, United
States Code, as added by subsection (a).
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