Infertility Coverage for Federal Employees, Military Personnel, and their Families Act - Requires any health benefits plan under the Federal Employees Health Benefit Program or TRICARE (a Department of Defense managed health care program) that provides obstetrical benefits to also provide coverage for the diagnosis and treatment of infertility, including nonexperimental assisted reproductive technology procedures.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1418 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 1418
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
March 17, 2005
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. SHORT TITLE.
This Act may be cited as the ``Infertility Coverage for Federal
Employees, Military Personnel, and their Families Act''.
SEC. 2. 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. 3. 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>
Introduced in House
Introduced in House
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.
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.
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.
Executive Comment Requested from DOD.
Referred to the Subcommittee on Military Personnel.
Referred to the Subcommittee on Readiness.
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