Prohibits group health plans and health insurance issuers from: (1) denying an individual eligibility or continuing eligibility to enroll or renew coverage because of the individual's or enrollee's use or potential use of items or services covered by this Act; (2) providing monetary payments or rebates to a covered individual to encourage the acceptance of less than minimum protections available under this Act; or (3) providing incentives to a health care professional to induce such professional to withhold infertility services from a covered individual.
Amends the PHSA to apply infertility benefits provisions to health insurance coverage offered by an issuer in the individual market in the same manner as they are applied to coverage in the group market.
Provides the infertility benefit coverage described by this Act for Federal employee health benefit plans.
[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.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S4892-4893)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S4893-4894)
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