[Congressional Record Volume 147, Number 65 (Monday, May 14, 2001)]
[Senate]
[Pages S4892-S4894]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. TORRICELLI:
  S. 874. A bill to require health plans to include infertility 
benefits, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. TORRICELLI. Mr. President, I rise today to reintroduce 
legislation that would greatly improve the lives of millions of 
Americans, thousands of whom live in my State of New Jersey, who are 
infertile. The Fair Access to Infertility Treatment and Hope, FAITH, 
Act first introduced during the 106th Congress, will again give hope to 
those families who have struggled silently for years with the knowledge 
that they cannot have children.
  For many American families, the blessing of raising a family is one 
of the most basic human desires. Unfortunately almost fifteen percent 
of all married couples, over six million American families, are unable 
to have children due to infertility.
  The physical and emotional toll that infertility has on families is 
impossible

[[Page S4893]]

to ignore. I have heard from a number of men and women from New Jersey 
who have experienced the pain and trauma of discovering that their 
bodies, which appear normal and function perfectly, are somehow 
deficient in the one area that matters most to them. This is only 
compounded when patients discover that their insurer, which they rely 
on for all of their critical health needs, refuse to cover treatment 
for this disease. The deep sense of loss expressed by those who desire 
a family as a result of this gap in coverage is real and significant. 
Their pain should no longer be ignored.
  Infertility is a treatable disease. New technologies and procedures 
that have been developed in the past two decades make starting a family 
a real possibility for many couples previously unable to conceive. In 
fact, up to two thirds of all married couples who seek infertility 
treatment are subsequently able to have children.
  Unfortunately, due to the high cost of treating this illness, only 20 
percent of infertile couples seek medical treatment each year. Even 
worse, only four out of every ten couples that seek infertility 
treatment receive coverage from health insurers, and only one quarter 
of all health plans provide coverage for infertility services.
  My bill will end this inequity by requiring all health insurance 
plans to ensure testing and coverage of infertility treatment. 
Specifically, FAITH requires health plans to cover all infertility 
procedures considered non-experimental that are deemed appropriate by 
patient and physician, up to four attempts, with two additional 
attempts provided for those successful couples that desire a second 
child.
  One reason often cited by health insurers for their continued refusal 
to provide infertility treatment is the negative impact that this 
coverage would have on monthly premiums. However, recent studies 
demonstrate that FAITH would raise the costs of health coverage by as 
little as $.21 cents per month per person, an insignificant amount 
compared to the enormous premium increases we have recently seen from 
HMOs.
  Similar legislation that recognizes the vital right of families to 
infertility treatments has already been passed in thirteen states, 
including Texas, California, New York, Illinois, Ohio, Massachusetts, 
Maryland, Connecticut, Rhode Island, Arkansas, Hawaii, Montana, and 
West Virginia. In my home state, both branches of the New Jersey 
Legislature recently passed legislation that mandates this coverage.
  Reproduction is one of the most important values for both men and 
women, and those individuals who desire the gift of family should have 
access to the necessary treatments that make life possible.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 874

       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,

[[Page S4894]]

     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.
                                 ______