I 

118TH CONGRESS 

2D SESSION H. R. 9643 

To protect and expand nationwide access to fertility treatment, including 

in vitro fertilization. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 17, 2024 

Ms. WILD (for herself, Mr. CONNOLLY, Ms. DELAURO, and Mr. LARSEN of 

Washington) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Veterans’ Affairs, Armed Services, Education and the Workforce, Ways 

and Means, and Oversight and Accountability, 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 protect and expand nationwide access to fertility 

treatment, including in vitro fertilization. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Right to IVF Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Severability. 


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TITLE I—ACCESS TO FAMILY BUILDING 

Sec. 101. Short title. 

Sec. 102. Purposes. 

Sec. 103. Definitions. 

Sec. 104. Fertility treatment rights. 

Sec. 105. Applicability and preemption. 

TITLE II—VETERAN FAMILIES HEALTH SERVICES 

Sec. 200. Short title. 

Subtitle A—Reproductive and Fertility Preservation Assistance for Members 

of the Uniformed Services 

Sec. 201. Definitions. 

Sec. 202. Provision of fertility treatment and counseling to certain members of 

the uniformed services and spouses, partners, and gestational 

surrogates of such members. 

Sec. 203. Establishment of fertility preservation procedures after an injury or 

illness. 

Sec. 204. Cryopreservation and storage of reproductive genetic material of 

members of the uniformed services on active duty. 

Sec. 205. Assistance with and continuity of care regarding reproductive and 

fertility preservation services. 

Sec. 206. Coordination between Department of Defense and Department of 

Veterans Affairs on furnishing of fertility treatment and counseling. 

Sec. 207. Regulations. 

Subtitle B—Reproductive Assistance for Veterans 

Sec. 211. Inclusion of fertility treatment and counseling under the definition of 

medical services in title 38. 

Sec. 212. Fertility treatment and counseling for certain veterans and spouses, 

partners, and gestational surrogates of such veterans. 

Sec. 213. Assistance with and continuity of care regarding reproductive and 

fertility preservation services. 

Sec. 214. Coordination of reproduction and fertility research for veterans. 

TITLE III—ACCESS TO FERTILITY TREATMENT AND CARE 

Sec. 301. Short title. 

Sec. 302. Standards relating to benefits for fertility treatment. 

Sec. 303. Requirement for State Medicaid plans To provide medical assistance 

for fertility treatment. 

Sec. 304. Medicare coverage of fertility treatment. 

TITLE IV—FAMILY BUILDING FEHB FAIRNESS 

Sec. 401. Short title. 

Sec. 402. Fertility treatment benefits. 


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1 SEC. 2. SEVERABILITY. 

2 If any provision of this Act, or the application of such 

3 provision to any person, entity, government, or cir4 cumstance is held to be unconstitutional, the remainder 

5 of this Act, or the application of such provision to all other 

6 persons, entities, governments, or circumstances shall not 

7 be affected thereby. 

8 TITLE I—ACCESS TO FAMILY 

9 BUILDING 

10 SEC. 101. SHORT TITLE. 

11 This title may be cited as the ‘‘Access to Family 

12 Building Act’’. 

13 SEC. 102. PURPOSES. 

14 The purposes of this title are as follows: 

15 (1) To permit patients to seek and receive fer16 tility treatment, including assisted reproductive tech17 nology services, and to permit health care providers 

18 that choose to provide fertility treatment, to provide 

19 such services without States enacting harmful or un20 warranted limitations or requirements that single 

21 out the provision of assisted reproductive services for 

22 restrictions that are not consistent with widely ac23 cepted and evidence-based medical standards of care, 

24 and which do not significantly advance reproductive 

25 health or the efficacy and safety of fertility treatVerDate Sep 11 2014 01:54 Oct 04, 2024 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H9643.IH H9643

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1 ment, or make fertility treatment more difficult to 

2 access. 

3 (2) To promote the right and ability of a pa4 tient residing in any State to choose to receive fer5 tility treatment provided in accordance with widely 

6 accepted and evidence-based medical standards of 

7 care by a health care provider who chooses to pro8 vide such services. 

9 (3) To protect an individual’s right to make de10 cisions, in consultation with the individual’s health 

11 care provider, about the most appropriate medical 

12 care to maximize the chance of becoming pregnant 

13 and giving birth to a healthy, living, human child 

14 with the help of fertility treatment. 

15 SEC. 103. DEFINITIONS. 

16 In this title: 

17 (1) FERTILITY TREATMENT.—The term ‘‘fer18 tility treatment’’ includes the following: 

19 (A) Preservation of human oocytes, sperm, 

20 or embryos for later reproductive use. 

21 (B) Artificial insemination, including 

22 intravaginal insemination, intracervical insemi23 nation, and intrauterine insemination. 

24 (C) Assisted reproductive technology, in25 cluding in vitro fertilization and other treatVerDate Sep 11 2014 01:54 Oct 04, 2024 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H9643.IH H9643

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1 ments or procedures in which reproductive ge2 netic material, such as oocytes, sperm, fertilized 

3 eggs, and embryos, are handled, when clinically 

4 appropriate. 

5 (D) Genetic testing of embryos. 

6 (E) Medications prescribed or obtained 

7 over-the-counter, as indicated for fertility. 

8 (F) Gamete donation. 

9 (G) Such other information, referrals, 

10 treatments, procedures, medications, laboratory 

11 testing, technologies, and services relating to 

12 fertility as the Secretary of Health and Human 

13 Services determines appropriate. 

14 (2) HEALTH CARE PROVIDER.—The term 

15 ‘‘health care provider’’ means any entity or indi16 vidual (including any physician, nurse practitioner, 

17 physician assistant, pharmacist, health care support 

18 personnel, clinical staff, and any other individual, as 

19 determined by the Secretary of Health and Human 

20 Services) that— 

21 (A) is engaged or seeks to engage in the 

22 delivery of fertility treatment, including through 

23 the provision of evidence-based information, 

24 counseling, referrals, or items and services that 


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1 relate to, aid in, or provide fertility treatment; 

2 and 

3 (B) if required by State law to be licensed, 

4 certified, or otherwise authorized to engage in 

5 the delivery of such services— 

6 (i) is so licensed, certified, or other7 wise authorized; or 

8 (ii) would be so licensed, certified, or 

9 otherwise authorized but for the fact that 

10 the individual or entity has provided, is 

11 providing, or plans to provide fertility 

12 treatment in accordance with section 104. 

13 (3) HEALTH INSURANCE ISSUER.—The term 

14 ‘‘health insurance issuer’’ has the meaning given 

15 such term in section 2791(b) of the Public Health 

16 Service Act (42 U.S.C. 300gg–91(b)). 

17 (4) MANUFACTURER.—The term ‘‘manufac18 turer’’ means the manufacturer of a drug or device 

19 approved, cleared, authorized, or licensed under sec20 tion 505, 510(k), 513(f)(2), or 515 of the Federal 

21 Food, Drug, and Cosmetic Act (21 U.S.C. 355, 

22 360(k), 360c(f)(2), 360e) or section 351 of the Pub23 lic Health Service Act (42 U.S.C. 262) or otherwise 

24 legally marketed. 


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1 (5) STATE.—The term ‘‘State’’ includes each of 

2 the 50 States, the District of Columbia, Puerto Rico, 

3 each territory and possession of the United States, 

4 and any political subdivision thereof. 

5 (6) WIDELY ACCEPTED AND EVIDENCE-BASED

6 MEDICAL STANDARDS OF CARE.—The term ‘‘widely 

7 accepted and evidence-based medical standards of 

8 care’’ means any medical services, procedures, and 

9 practices that are in accordance with the guidelines 

10 of the American Society for Reproductive Medicine. 

11 SEC. 104. FERTILITY TREATMENT RIGHTS. 

12 (a) GENERAL RULE.— 

13 (1) INDIVIDUAL RIGHTS.—An individual has a 

14 statutory right under this title, without prohibition, 

15 limitation, interference, or impediment, to the extent 

16 that such prohibition, limitation, interference, or im17 pediment in any way or degree obstructs, delays, or 

18 affects commerce over which the Federal Govern19 ment has jurisdiction, to— 

20 (A) receive fertility treatment from a 

21 health care provider, in accordance with widely 

22 accepted and evidence-based medical standards 

23 of care; 

24 (B) continue or complete an ongoing fer25 tility treatment previously initiated by a health 


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1 care provider, in accordance with widely accept2 ed and evidence-based medical standards of 

3 care; 

4 (C) make decisions and arrangements re5 garding the donation, testing, use, storage, or 

6 disposition of reproductive genetic material, 

7 such as oocytes, sperm, fertilized eggs, and em8 bryos; and 

9 (D) establish contractual agreements with 

10 a health care provider relating to the health 

11 care provider’s services in handling, testing, 

12 storing, shipping, and disposing of the individ13 ual’s reproductive genetic material in accord14 ance with widely accepted and evidence-based 

15 medical standards of care. 

16 (2) HEALTH CARE PROVIDER RIGHTS.—A 

17 health care provider has a statutory right under this 

18 title, without prohibition, limitation, interference, or 

19 impediment, to the extent that such prohibition, lim20 itation, interference, or impediment in any way or 

21 degree obstructs, delays, or affects commerce over 

22 which the Federal Government has jurisdiction, to— 

23 (A) provide, or assist with the provision of, 

24 fertility treatment provided in accordance with 


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1 widely accepted and evidence-based medical 

2 standards of care; 

3 (B) continue or complete the provision of, 

4 or assistance with, fertility treatment that was 

5 lawful when commenced and is provided in ac6 cordance with widely accepted and evidence7 based medical standards of care; 

8 (C) provide for, or assist with, the testing, 

9 use, storage, or disposition of reproductive ge10 netic material, such as oocytes, sperm, fertilized 

11 eggs, and embryos, in accordance with widely 

12 accepted and evidence-based medical standards 

13 of care; and 

14 (D) establish contractual agreements with 

15 individuals or manufacturers relating to the 

16 health care provider’s services in handling, test17 ing, storing, shipping, and disposing of the indi18 vidual’s reproductive genetic material. 

19 (3) HEALTH INSURANCE ISSUER RIGHTS.—A 

20 health insurance issuer has a statutory right under 

21 this title, without prohibition, limitation, inter22 ference, or impediment, to the extent that such pro23 hibition, limitation, interference, or impediment in 

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1 diction, to cover the provision of fertility treatment 

2 provided in accordance with widely accepted and evi3 dence-based medical standards of care. 

4 (4) MANUFACTURER RIGHTS.—A manufacturer 

5 of a drug or device that is approved, cleared, author6 ized, or licensed under section 505, 510(k), 

7 513(f)(2), or 515 of the Federal Food, Drug, and 

8 Cosmetic Act (21 U.S.C. 355; 360(k); 360c(f)(2); 

9 360e) or section 351 of the Public Health Service 

10 Act (42 U.S.C. 262) or otherwise legally marketed 

11 and intended for use in the provision of fertility 

12 treatment, including the storage or transport of oo13 cytes, gametes, fertilized eggs, and embryos, has a 

14 statutory right under this title, without prohibition, 

15 limitation, interference, or impediment, to the extent 

16 that such prohibition, limitation, interference, or im17 pediment in any way or degree obstructs, delays, or 

18 affects commerce over which the Federal Govern19 ment has jurisdiction, to manufacture, import, mar20 ket, sell, and distribute such drug or device. 

21 (b) STATE REGULATION OF MEDICINE.—The en22 forcement of State health and safety law regarding med23 ical facilities or health care providers does not constitute 

24 a violation of subsection (a) if— 


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1 (1) such regulations are in accordance with 

2 widely accepted and evidence-based medical stand3 ards of care for providing fertility treatment; and 

4 (2) the safety or health objective cannot be ad5 vanced by a different means that does not prohibit, 

6 limit, interfere with, or impede the rights described 

7 in subsection (a). 

8 (c) ENFORCEMENT.— 

9 (1) THE ATTORNEY GENERAL.— 

10 (A) IN GENERAL.—The Attorney General 

11 may commence a civil action on behalf of the 

12 United States against any State; an individual, 

13 employee, official, agency head, contractor, or14 ganization, or instrumentality acting for, or on 

15 behalf of, such a State; or any individual acting 

16 under the color of, or pursuant to, State law, 

17 that implements, enforces, or threatens to en18 force a limitation or requirement that prohibits, 

19 limits, interferes with, or impedes the statutory 

20 rights of an individual, a health care provider, 

21 a health insurance issuer, or a manufacturer 

22 under subsection (a). 

23 (B) EFFECT OF VIOLATIONS.—The court 

24 shall hold unlawful and set aside a limitation or 


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1 requirement described in subparagraph (A) if it 

2 is in violation of subsection (a). 

3 (2) PRIVATE RIGHT OF ACTION.— 

4 (A) IN GENERAL.—Any individual or entity 

5 adversely affected by an alleged violation of 

6 subsection (a) may commence a civil action 

7 against an individual, employee, official, agency 

8 head, contractor, organization, or instrumen9 tality acting for, or on behalf of, such a State 

10 that enacts, implements, or enforces a limita11 tion or requirement that prohibits, limits, inter12 feres with, or impedes the statutory rights of an 

13 individual, a health care provider, a health in14 surance issuer, or a manufacturer under sub15 section (a). 

16 (B) EFFECT OF VIOLATIONS.—The court 

17 shall hold unlawful and enjoin a limitation or 

18 requirement described in subparagraph (A) if it 

19 is in violation of subsection (a). 

20 (3) HEALTH CARE PROVIDER.— 

21 (A) IN GENERAL.—A health care provider 

22 may commence a civil action for relief on such 

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1 tients who are or may be adversely affected by 

2 an alleged violation of subsection (a). 

3 (B) EFFECT OF VIOLATIONS.—The court 

4 shall hold unlawful and enjoin a limitation or 

5 requirement described in subparagraph (A) if it 

6 is in violation of subsection (a). 

7 (4) EQUITABLE RELIEF.—In any action under 

8 this section, the court may award appropriate equi9 table relief, including temporary, preliminary, or per10 manent injunctive relief. 

11 (5) COSTS.— 

12 (A) IN GENERAL.—In any action under 

13 this section, the court shall award costs of liti14 gation, as well as reasonable attorney’s fees, to 

15 any prevailing plaintiff. 

16 (B) LIABILITY OF PLAINTIFFS.—A plain17 tiff shall not be liable to a defendant for costs 

18 or attorney’s fees in any non-frivolous action 

19 under this section unless such costs or attor20 ney’s fees are imposed by the court as part of 

21 sanctions for violations committed during the 

22 discovery process. 

23 (6) JURISDICTION.—The district courts of the 

24 United States shall have jurisdiction over pro25 ceedings under this section and shall exercise the 


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1 same without regard to whether the party aggrieved 

2 shall have exhausted any administrative or other 

3 remedies that may be provided for by law. 

4 (7) RIGHT TO REMOVE.— 

5 (A) IN GENERAL.—Any party shall have a 

6 right to remove an action brought under this 

7 subsection to the district court of the United 

8 States for the district and division embracing 

9 the place where such action is pending. 

10 (B) REVIEW.—An order remanding the 

11 case to the State court from which it was re12 moved under this paragraph is immediately re13 viewable by appeal or otherwise. 

14 (d) REGULATIONS.—Not later than 180 days after 

15 the date of enactment of this Act, the Secretary of Health 

16 and Human Services shall promulgate regulations to carry 

17 out this section. 

18 (e) RULES OF CONSTRUCTION.— 

19 (1) IN GENERAL.—For purposes of this title, a 

20 State law, or the administration, implementation, or 

21 enforcement of a State law, constitutes a prohibi22 tion, limitation, interference, or impediment on a 

23 health care provider providing, an individual receiv24 ing, a health insurance issuer covering, or a manu25 facturer marketing drugs or devices for fertility 


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1 treatment, provided in accordance with widely ac2 cepted and evidence-based medical standards of care, 

3 as described in subsection 104, if the administration, 

4 implementation, interpretation, or enforcement of 

5 such law has an effect that— 

6 (A) imposes requirements or limitations 

7 that are inconsistent with providing, receiving, 

8 providing health insurance coverage for, or pro9 viding drugs or devices for fertility treatment in 

10 accordance with widely accepted and evidence11 based medical standards of care or that other12 wise violate the purpose and requirements of 

13 this Act, which may include— 

14 (i) requiring that a health care pro15 vider provide, and patients undertake, 

16 medically unnecessary procedures and serv17 ices, including tests and procedures, pro18 viding medically inaccurate information re19 garding fertility treatment, or requiring 

20 additional unnecessary in-person visits to a 

21 health care provider, that are inconsistent 

22 with widely accepted and evidence-based 

23 medical standards of care; 

24 (ii) imposing limitations or require25 ments concerning physical offices, clinics, 


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1 facilities, equipment, staffing, or hospital 

2 transfer arrangements of facilities where 

3 fertility treatment is provided, or the cre4 dentials or hospital privileges or status of 

5 personnel at such facilities, that are not 

6 consistent with widely accepted and evi7 dence-based medical standards of care; or 

8 (iii) limiting a health care provider’s 

9 right or ability to provide, or a patient’s 

10 right to receive, or imposing limitations 

11 that reduce the efficacy of, fertility treat12 ment in accordance with widely accepted 

13 and evidence-based medical standards of 

14 care, including retrieval of multiple eggs 

15 during oocyte retrieval; performance of in16 semination procedures, including intra17 uterine insemination; intracytoplasmic 

18 sperm injections to fertilize multiple 

19 human eggs; and cryopreservation of one 

20 or more eggs or embryos for fertility pres21 ervation and subsequent transfer, if deter22 mined appropriate by the health care pro23 vider and patient; 

24 (B) infringes, limits, or restricts the ability 

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1 ance issuer, or manufacturer, to exercise or en2 force their statutory rights under this title on 

3 the basis of marital status, sex (including sex4 ual orientation and gender identity) or any 

5 other protected class that is covered by Federal 

6 law; 

7 (C) limits a health care provider’s or pa8 tient’s right or ability to determine the most ap9 propriate disposition of fertilized eggs or em10 bryos, including by defining a gamete or em11 bryo in such a way as to prevent the disposition 

12 of gametes and embryos; 

13 (D) limits a health care provider’s ability 

14 to provide, or a patient’s ability to receive, fer15 tility treatment via telemedicine, in accordance 

16 with widely accepted and evidence-based med17 ical standards of care; 

18 (E) limits or prohibits a health care pro19 vider’s ability to provide, or a patient’s ability 

20 to receive, fertility counseling or fertility treat21 ment based on the residency of the patient, or 

22 prohibits or limits the ability of any individual 

23 to assist or support a patient seeking fertility 

24 treatment; 


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1 (F) imposes requirements or limitations 

2 that compel health care providers to provide, or 

3 patients to receive, medically unnecessary care, 

4 or withhold medically necessary care, in a man5 ner that is not consistent with widely accepted 

6 and evidence-based medical standards of care 

7 for fertility treatment, including mandating the 

8 transfer of embryos that a health care provider 

9 would not reasonably expect, based on widely 

10 accepted and evidence-based medical standards 

11 of care, to lead to a healthy pregnancy or a live 

12 birth; 

13 (G) limits a health care provider’s right or 

14 ability to prescribe or dispense, or a patient’s 

15 right or ability to receive or use, medications 

16 for fertility treatment in accordance with widely 

17 accepted and evidence-based medical standards 

18 of care, unless such a limitation is generally ap19 plicable to the prescription, dispensing, or dis20 tribution of medications; or 

21 (H) limits a health care provider’s right or 

22 ability to perform a human sperm retrieval pro23 cedure in accordance with widely accepted and 

24 evidence-based medical standards of care. 


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1 (2) CLARIFICATION.—The descriptions of spe2 cific State laws that would violate the statutory 

3 rights and protections described in paragraph (1) 

4 shall not be construed to limit potential violations of 

5 the statutory rights and protections under this title 

6 to only the restrictions and limitations listed in 

7 paragraph (1), and potential violations of this title 

8 may result from novel State restrictions and limita9 tions that are not listed under paragraph (1). 

10 (3) EXCLUSION.—It shall not constitute a pro11 hibition, limitation, interference, or impediment to a 

12 health care provider providing, an individual receiv13 ing, a health insurance issuer covering, or a manu14 facturer marketing a drug or device for purposes of, 

15 fertility treatment under this title for an entity to 

16 act in compliance with the Food and Drug Adminis17 tration’s regulation of drugs, devices, biological 

18 products, human cells, tissues, or cellular or tissue19 based products used in fertility treatment, consistent 

20 with widely accepted and evidence-based medical 

21 standards of care for fertility treatment. 

22 SEC. 105. APPLICABILITY AND PREEMPTION. 

23 (a) IN GENERAL.— 

24 (1) GENERAL APPLICATION.— 


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1 (A) EFFECT ON STATE LAW.—This title 

2 supersedes any State law that is inconsistent 

3 with the statutory rights established under this 

4 title and precludes the implementation of such 

5 a law, whether statutory, common law, or other6 wise, and whether adopted before or after the 

7 date of enactment of this Act. 

8 (B) PROHIBITION.—No State shall admin9 ister, implement, or enforce any law, rule, regu10 lation, standard, or other provision having the 

11 force and effect of law that conflicts with any 

12 provision of this title, notwithstanding any 

13 other provision of Federal law. 

14 (2) EXCLUSION.—Preemption of State law 

15 under paragraph (1) does not apply to— 

16 (A) State law regarding the resolution of 

17 disputes between 2 individuals with rights de18 scribed in section 104(a)(1) with respect to the 

19 same reproductive genetic material, such as oo20 cytes, sperm, fertilized eggs, and embryos; or 

21 (B) any other State law, to the extent that 

22 such law does not conflict with this title and 

23 protects an individual’s right and ability to re24 ceive fertility treatment in accordance with 

25 widely accepted and evidence-based medical 


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1 standards of care, including any such law that 

2 holds a health care provider accountable for not 

3 providing fertility treatment in accordance with 

4 widely accepted and evidence-based medical 

5 standards of care. 

6 (3) PRESERVATION OF FEDERAL PUBLIC

7 HEALTH AUTHORITIES.—Nothing in this title shall 

8 have the effect of superseding, negating, or limiting 

9 provisions of Federal law, including the Federal 

10 Food, Drug, and Cosmetic Act (21 U.S.C. 301 et 

11 seq.) or the Public Health Service Act (42 U.S.C. 

12 201 et seq.), and regulations promulgated under 

13 such statutes, with respect to the regulation of 

14 drugs, devices, biological products, human cells, tis15 sues, or cellular or tissue-based products used in fer16 tility treatment. 

17 (4) PRESERVATION OF HIPAA RULES.—Nothing 

18 in this title shall have the effect of superseding, ne19 gating, or limiting the provisions of the privacy, se20 curity, and breach notification regulations in parts 

21 160 and 164 of title 45, Code of Federal Regula22 tions (or successor regulations). 

23 (5) SUBSEQUENTLY ENACTED FEDERAL LEGIS24 LATION.—Federal statutory law adopted after the 

25 date of the enactment of this Act is subject to this 


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1 title unless such law explicitly excludes such applica2 tion by reference to this title. 

3 (b) DEFENSE.—In any cause of action against an in4 dividual or entity who is subject to a limitation or require5 ment that violates this title, in addition to the remedies 

6 specified in section 104(b), this title shall also apply to, 

7 and may be raised as a defense by, such an individual or 

8 entity. 

9 TITLE II—VETERAN FAMILIES 

10 HEALTH SERVICES 

11 SEC. 200. SHORT TITLE. 

12 This title may be cited as the ‘‘Veteran Families 

13 Health Services Act’’. 

14 Subtitle A—Reproductive and Fer15 tility Preservation Assistance 

16 for Members of the Uniformed 

17 Services 

18 SEC. 201. DEFINITIONS. 

19 In this subtitle: 

20 (1) ACTIVE DUTY.—The term ‘‘active duty’’ has 

21 the meaning given that term in section 101(18) of 

22 title 37, United States Code. 

23 (2) UNIFORMED SERVICES.—The term ‘‘uni24 formed services’’ has the meaning given that term in 

25 section 101(a)(5) of title 10, United States Code. 


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1 SEC. 202. PROVISION OF FERTILITY TREATMENT AND 

2 COUNSELING TO CERTAIN MEMBERS OF THE 

3 UNIFORMED SERVICES AND SPOUSES, PART4 NERS, AND GESTATIONAL SURROGATES OF 

5 SUCH MEMBERS. 

6 (a) FERTILITY TREATMENT AND COUNSELING.— 

7 (1) IN GENERAL.—The Secretary of Defense 

8 shall make available fertility treatment and coun9 seling to a member of the uniformed services or a 

10 spouse, partner, or gestational surrogate of such a 

11 member. 

12 (2) ELIGIBILITY FOR TREATMENT AND COUN13 SELING.—Fertility treatment and counseling shall be 

14 furnished under paragraph (1) without regard to the 

15 sex, sex characteristics, gender identity, sexual ori16 entation, infertility diagnosis, or marital status of 

17 the member of the uniformed services or their part18 ner. 

19 (3) IN VITRO FERTILIZATION.—In the case of 

20 in vitro fertilization treatment furnished under para21 graph (1), the Secretary may furnish to an indi22 vidual under such paragraph— 

23 (A) not more than three completed oocyte 

24 retrievals; and 

25 (B) unlimited embryo transfers. 


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1 (b) PROCUREMENT OF REPRODUCTIVE GENETIC MA2 TERIAL.—If a member of the uniformed services is unable 

3 to provide their reproductive genetic material, such as oo4 cytes, sperm, fertilized eggs, and embryos, for purposes 

5 of fertility treatment under subsection (a), the Secretary 

6 shall, at the election of such member, allow such member 

7 to receive such treatment with donated reproductive ge8 netic material and pay or reimburse such member the rea9 sonable costs of procuring such material from a donor. 

10 (c) RULES OF CONSTRUCTION.— 

11 (1) IMPACT ON EXISTING AUTHORITY.—Noth12 ing in this section shall be construed to rescind the 

13 authority of the Secretary to provide in vitro fer14 tilization benefits pursuant to section 1074(c)(4) of 

15 title 10, United States Code. 

16 (2) SOURCING OF GESTATIONAL SURROGATE OR

17 REPRODUCTIVE GENETIC MATERIAL.—Nothing in 

18 this section shall be construed to require the Sec19 retary— 

20 (A) to find or certify a gestational surro21 gate for a member of the uniformed services or 

22 to connect a gestational surrogate with such a 

23 member; or 

24 (B) to find or certify reproductive genetic 

25 material, such as oocytes, sperm, fertilized eggs, 


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1 and embryos, from a donor for a member of the 

2 uniformed services or to connect such a member 

3 with reproductive genetic material from a 

4 donor. 

5 (d) DEFINITIONS.—In this section: 

6 (1) FERTILITY TREATMENT.—The term ‘‘fer7 tility treatment’’ includes the following: 

8 (A) Preservation of human oocytes, sperm, 

9 or embryos for later reproductive use. 

10 (B) Artificial insemination, including 

11 intravaginal insemination, intracervical insemi12 nation, and intrauterine insemination. 

13 (C) Assisted reproductive technology, in14 cluding in vitro fertilization and other treat15 ments or procedures in which reproductive ge16 netic material, such as oocytes, sperm, fertilized 

17 eggs, and embryos, are handled, when clinically 

18 appropriate. 

19 (D) Genetic testing of embryos. 

20 (E) Medications prescribed or obtained 

21 over-the-counter, as indicated for fertility. 

22 (F) Gamete donation. 

23 (G) Such other information, referrals, 

24 treatments, procedures, medications, laboratory 

25 testing, technologies, and services relating to 


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1 fertility as the Secretary of Defense determines 

2 appropriate. 

3 (2) GESTATIONAL SURROGATE.—The term 

4 ‘‘gestational surrogate’’ means an individual who 

5 agrees to become pregnant through in vitro fertiliza6 tion under a gestational surrogacy agreement using 

7 gametes that are not the gametes of that individual. 

8 (3) PARTNER.—The term ‘‘partner’’, with re9 spect to a member of the uniformed services, means 

10 an individual selected by the member who agrees to 

11 be a parent, with the member, of a child born as a 

12 result of the use of any fertility treatment under this 

13 section. 

14 SEC. 203. ESTABLISHMENT OF FERTILITY PRESERVATION 

15 PROCEDURES AFTER AN INJURY OR ILLNESS. 

16 (a) IN GENERAL.—The Secretary of Defense, acting 

17 through the Assistant Secretary of Defense for Health Af18 fairs, shall establish procedures for the retrieval of repro19 ductive genetic material, such as oocytes, sperm, fertilized 

20 eggs, and embryos, as soon as medically appropriate, from 

21 a member of the uniformed services in cases in which the 

22 fertility of such member is potentially jeopardized as a re23 sult of an injury or illness incurred or aggravated while 

24 serving on active duty in the uniformed services in order 

25 to preserve the medical options of such member. 


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1 (b) INCLUSION OF INFORMATION IN ADVANCED DI2 RECTIVES AND MILITARY TESTAMENTARY INSTRU3 MENTS.—The Secretary of Defense shall ensure that any 

4 advance medical directive, as defined in section 1044c(b) 

5 of title 10, United States Code, or military testamentary 

6 instrument, as defined in section 1044d(b) of such title, 

7 completed by a member of the uniformed services includes 

8 questions about the consent of the member to fertility 

9 preservation procedures under subsection (a). 

10 (c) DISPOSAL OF REPRODUCTIVE GENETIC MATE11 RIAL.—Subject to section 204, in accordance with regula12 tions prescribed by the Secretary for purpose of this sub13 section, the Secretary shall dispose of reproductive genetic 

14 material retrieved from a member of the uniformed serv15 ices under subsection (a)— 

16 (1) with the specific consent of the member; or 

17 (2) if the member— 

18 (A) has lost the ability to consent perma19 nently, as determined by a medical professional, 

20 or has died; and 

21 (B) has not specified the use of their re22 productive genetic material in an advance direc23 tive or testamentary instrument executed by the 

24 member. 


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1 SEC. 204. CRYOPRESERVATION AND STORAGE OF REPRO2 DUCTIVE GENETIC MATERIAL OF MEMBERS 

3 OF THE UNIFORMED SERVICES ON ACTIVE 

4 DUTY. 

5 (a) IN GENERAL.—The Secretary of Defense shall 

6 provide members of the uniformed services on active duty 

7 in the uniformed services with the opportunity to 

8 cryopreserve and store their reproductive genetic material, 

9 such as oocytes, sperm, fertilized eggs, and embryos, prior 

10 to— 

11 (1) deployment to a combat zone; or 

12 (2) a duty assignment that includes a haz13 ardous assignment, including— 

14 (A) assignments resulting in exposure to 

15 perfluoroalkyl or polyfluoroalkyl substances; 

16 and 

17 (B) such other assignments as determined 

18 by the Secretary. 

19 (b) PERIOD OF TIME.— 

20 (1) IN GENERAL.—The Secretary shall provide 

21 for the cryopreservation and storage of reproductive 

22 genetic material of any member of the uniformed 

23 services under subsection (a) in a facility of the De24 partment of Defense or of a private entity and the 

25 transportation of such material, at no cost to the 

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1 tirement, separation, or release of the member from 

2 the uniformed services. 

3 (2) CONTINUED CRYOPRESERVATION AND

4 STORAGE.—At the end of the one-year period speci5 fied in paragraph (1), the Secretary shall permit an 

6 individual whose reproductive genetic material was 

7 cryopreserved and stored as described in that para8 graph to select, including pursuant to an advance 

9 medical directive or military testamentary instru10 ment completed under subsection (c), one of the fol11 lowing options: 

12 (A) To continue such cryopreservation and 

13 storage in such facility with the cost of such 

14 cryopreservation and storage borne by the indi15 vidual. 

16 (B) To transfer the material to a private 

17 cryopreservation and storage facility selected by 

18 the individual. 

19 (C) To transfer the material to a facility of 

20 the Department of Veterans Affairs if 

21 cryopreservation and storage is available to the 

22 individual at such facility and the individual is 

23 eligible for such services. 

24 (3) DISPOSAL OF REPRODUCTIVE GENETIC MA25 TERIAL.— 


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1 (A) NO SELECTION.—If an individual de2 scribed in paragraph (2) does not make a selec3 tion under subparagraph (A), (B), or (C) of 

4 such paragraph, the Secretary may dispose of 

5 the reproductive genetic material of the indi6 vidual not earlier than the date that is 90 days 

7 after the end of the one-year period specified in 

8 paragraph (1) with respect to the individual. 

9 (B) ELECTION BY INDIVIDUAL.—At the 

10 election of an individual described in paragraph 

11 (2), the Secretary may dispose of the reproduc12 tive genetic material of the individual. 

13 (c) ADVANCE MEDICAL DIRECTIVE AND MILITARY

14 TESTAMENTARY INSTRUMENT.—A member of the uni15 formed services who elects to cryopreserve and store their 

16 reproductive genetic material under this section must com17 plete an advance medical directive, as defined in section 

18 1044c(b) of title 10, United States Code, and a military 

19 testamentary instrument, as defined in section 1044d(b) 

20 of such title, that explicitly specifies the use of their 

21 cryopreserved and stored reproductive genetic material if 

22 such member dies or otherwise loses the capacity to con23 sent to the use of their cryopreserved and stored reproduc24 tive genetic material. 


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1 (d) AGREEMENTS.—To carry out this section, the 

2 Secretary may enter into agreements with private entities 

3 that provide cryopreservation, transportation, and storage 

4 services for reproductive genetic material. 

5 SEC. 205. ASSISTANCE WITH AND CONTINUITY OF CARE RE6 GARDING REPRODUCTIVE AND FERTILITY 

7 PRESERVATION SERVICES. 

8 The Secretary of Defense shall ensure that employees 

9 of the Department of Defense assist members of the uni10 formed services— 

11 (1) in navigating the services provided under 

12 this subtitle; 

13 (2) in finding a provider that meets the needs 

14 of such members with respect to such services; and 

15 (3) in continuing the receipt of such services 

16 without interruption during a permanent change of 

17 station for such members. 

18 SEC. 206. COORDINATION BETWEEN DEPARTMENT OF DE19 FENSE AND DEPARTMENT OF VETERANS AF20 FAIRS ON FURNISHING OF FERTILITY TREAT21 MENT AND COUNSELING. 

22 (a) IN GENERAL.—The Secretary of Defense and the 

23 Secretary of Veterans Affairs shall share best practices 

24 and facilitate referrals, as they consider appropriate, on 

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1 dividuals eligible for the receipt of such counseling and 

2 treatment from the Secretaries. 

3 (b) MEMORANDUM OF UNDERSTANDING.—The Sec4 retary of Defense and the Secretary of Veterans Affairs 

5 shall enter into a memorandum of understanding— 

6 (1) providing that the Secretary of Defense will 

7 ensure access by the Secretary of Veterans Affairs 

8 to reproductive genetic material, such as oocytes, 

9 sperm, fertilized eggs, and embryos, of veterans 

10 stored by the Department of Defense for purposes of 

11 furnishing fertility treatment under section 1720K 

12 of title 38, United States Code, as added by section 

13 212(a); and 

14 (2) authorizing the Department of Veterans Af15 fairs to compensate the Department of Defense for 

16 the cryopreservation, transportation, and storage of 

17 reproductive genetic material of veterans under sec18 tion 204(b)(2)(A). 

19 SEC. 207. REGULATIONS. 

20 Not later than two years after the date of the enact21 ment of this Act, the Secretary of Defense shall prescribe 

22 regulations to carry out this subtitle. 


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1 Subtitle B—Reproductive 

2 Assistance for Veterans 

3 SEC. 211. INCLUSION OF FERTILITY TREATMENT AND 

4 COUNSELING UNDER THE DEFINITION OF 

5 MEDICAL SERVICES IN TITLE 38. 

6 Section 1701(6) of title 38, United States Code, is 

7 amended by adding at the end the following new subpara8 graph: 

9 ‘‘(J) Fertility treatment and counseling 

10 under section 1720K of this title.’’. 

11 SEC. 212. FERTILITY TREATMENT AND COUNSELING FOR 

12 CERTAIN VETERANS AND SPOUSES, PART13 NERS, AND GESTATIONAL SURROGATES OF 

14 SUCH VETERANS. 

15 (a) IN GENERAL.—Subchapter II of chapter 17 of 

16 title 38, United States Code, is amended by adding at the 

17 end the following new section: 

18 ‘‘§ 1720K. Fertility treatment and counseling for cer19 tain veterans and spouses, partners, and 

20 gestational surrogates of such veterans 

21 ‘‘(a) REQUIREMENT.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding any other 

23 provision of law, including the surrogacy laws of any 

24 State, the Secretary shall furnish fertility treatment 

25 and counseling for the benefit of a covered veteran 


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1 to the veteran and the spouse, partner, gamete 

2 donor, or gestational surrogate of the veteran if the 

3 veteran, and the spouse, partner, gamete donor, or 

4 gestational surrogate of the veteran, as applicable, 

5 each provide informed consent for such treatment 

6 and counseling, including for each cycle of treatment 

7 authorized under this section, through a process pre8 scribed by the Secretary. 

9 ‘‘(2) PROVISION OF TREATMENT AND COUN10 SELING.—Fertility treatment and counseling shall be 

11 furnished under paragraph (1) without regard to the 

12 sex, sexual characteristics, gender identity, sexual 

13 orientation, infertility diagnosis, or marital status of 

14 the covered veteran or their partner. 

15 ‘‘(3) IN VITRO FERTILIZATION.—In the case of 

16 in vitro fertilization treatment furnished under para17 graph (1), the Secretary may furnish to an indi18 vidual under such paragraph— 

19 ‘‘(A) not more than three completed oocyte 

20 retrievals; and 

21 ‘‘(B) unlimited embryo transfers. 

22 ‘‘(4) COPAYMENT.—The Secretary shall only 

23 furnish fertility treatment and counseling under 

24 paragraph (1) to a covered veteran who is required 

25 to pay to the United States a copayment amount as 


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1 a condition for the receipt of hospital care, medical 

2 services, or medications under this chapter if the 

3 covered veteran agrees to pay such applicable copay4 ment amount to the United States for such treat5 ment and counseling. 

6 ‘‘(b) PROCUREMENT OF REPRODUCTIVE GENETIC

7 MATERIAL.— 

8 ‘‘(1) IN GENERAL.—If a covered veteran is un9 able to provide their reproductive genetic material 

10 for purposes of fertility treatment under subsection 

11 (a), the Secretary shall, at the election of such vet12 eran— 

13 ‘‘(A) allow such veteran to receive such 

14 treatment with donated reproductive genetic 

15 material, if the donor provides informed consent 

16 for use of such material; and 

17 ‘‘(B) pay or reimburse the veteran, donor, 

18 or a party acting on behalf of the donor the 

19 reasonable costs of procuring such material 

20 from the donor. 

21 ‘‘(2) OTHER EXPENSES.—The Secretary may 

22 pay or reimburse a covered veteran a reasonable 

23 amount for personal travel and incidental expenses 

24 associated with procuring material from a donor 

25 under paragraph (1). 


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1 ‘‘(c) OUTREACH AND TRAINING.—The Secretary 

2 shall carry out an outreach and training program to en3 sure veterans and health care providers of the Department 

4 are aware of— 

5 ‘‘(1) the availability of and eligibility require6 ments for fertility treatment and counseling under 

7 this section; and 

8 ‘‘(2) any changes to fertility treatment and 

9 counseling covered under this section. 

10 ‘‘(d) OWNERSHIP, USE, OR DISPOSITION OF REPRO11 DUCTIVE GENETIC MATERIAL.— 

12 ‘‘(1) IN GENERAL.—Issues or disputes regard13 ing ownership of reproductive genetic material or fu14 ture use or disposition of such material shall be the 

15 sole responsibility of the covered veteran, the spouse, 

16 partner, or gestational surrogate of the veteran, as 

17 applicable, and the private facility storing such ma18 terial. 

19 ‘‘(2) AGREEMENT REGARDING DONATED RE20 PRODUCTIVE GENETIC MATERIAL.—As a condition 

21 of the use of donated gametes or embryos under this 

22 section, the third-party donor and a provider of fer23 tility treatment that has entered into a contract or 

24 agreement with the Secretary to provide such treat25 ment under this section are required to enter into an 


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1 arrangement or agreement governing the terms of 

2 the donation, to include ultimate disposition of any 

3 remaining gametes or embryos once a covered vet4 eran has exhausted the fertility treatment available 

5 under this section, unless the veteran or the spouse 

6 or partner of the veteran has agreed to assume li7 ability for the continued preservation of any remain8 ing gametes or embryos and the Department is not 

9 party to the arrangement or agreement for such con10 tinued preservation. 

11 ‘‘(3) ROLE OF DEPARTMENT.—The role of the 

12 Secretary under this section is limited to furnishing 

13 the treatment and counseling required under this 

14 section when requested by a covered veteran and de15 termined necessary by the Secretary. 

16 ‘‘(4) OWNERSHIP AND CUSTODY OF REPRODUC17 TIVE GENETIC MATERIAL.—The Secretary will not 

18 have ownership or custody of any reproductive ge19 netic material obtained pursuant to treatment under 

20 this section and will not be involved in the ultimate 

21 disposition of such material or disputes between or 

22 among any parties with respect to such material. 

23 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec24 tion shall be construed to require the Secretary— 


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1 ‘‘(1) to find or certify a gestational surrogate 

2 for a covered veteran or to connect a gestational sur3 rogate with a covered veteran; or 

4 ‘‘(2) to furnish maternity care to a covered vet5 eran or spouse, partner, or gestational surrogate of 

6 a covered veteran beyond what is otherwise required 

7 or authorized by law. 

8 ‘‘(f) DEFINITIONS.—In this section: 

9 ‘‘(1) The term ‘covered veteran’ means a vet10 eran who is enrolled in the system of annual patient 

11 enrollment established under section 1705(a) of this 

12 title. 

13 ‘‘(2) The term ‘fertility treatment’ includes the 

14 following: 

15 ‘‘(A) Preservation of human oocytes, 

16 sperm, or embryos for later reproductive use. 

17 ‘‘(B) Artificial insemination, including 

18 intravaginal insemination, intracervical insemi19 nation, and intrauterine insemination. 

20 ‘‘(C) Assisted reproductive technology, in21 cluding in vitro fertilization and other treat22 ments or procedures in which reproductive ge23 netic material, such as oocytes, sperm, fertilized 

24 eggs, and embryos, are handled, when clinically 

25 appropriate. 


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1 ‘‘(D) Genetic testing of embryos. 

2 ‘‘(E) Medications prescribed or obtained 

3 over-the-counter, as indicated for fertility. 

4 ‘‘(F) Gamete donation. 

5 ‘‘(G) Such other information, referrals, 

6 treatments, procedures, medications, laboratory 

7 testing, technologies, and services relating to 

8 fertility as the Secretary determines appro9 priate. 

10 ‘‘(3) The term ‘gestational surrogate’ means an 

11 individual who agrees to become pregnant through in 

12 vitro fertilization under a gestational surrogacy 

13 agreement using gametes that are not the gametes 

14 of that individual. 

15 ‘‘(4) The term ‘partner’, with respect to a cov16 ered veteran, means an individual selected by the 

17 veteran who agrees to be a parent, with the veteran, 

18 of a child born as a result of the use of any fertility 

19 treatment under this section.’’. 

20 (b) CLERICAL AMENDMENT.—The table of sections 

21 at the beginning of subchapter II of chapter 17 of such 

22 title is amended by inserting after the item relating to sec23 tion 1720J the following new item: 

‘‘1720K. Fertility treatment and counseling for certain veterans and spouses, 

partners, and gestational surrogates of such veterans.’’. 


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1 (c) SUNSET OF EXISTING AUTHORITY.—The author2 ity under section 234 of the Military Construction, Vet3 erans Affairs, and Related Agencies Appropriations Act, 

4 2024 (division A of Public Law 118–42), or any similar 

5 authority subsequently enacted by law, shall cease on the 

6 effective date of regulations prescribed to carry out section 

7 1720K of title 38, United States Code, as added by sub8 section (a). 

9 SEC. 213. ASSISTANCE WITH AND CONTINUITY OF CARE RE10 GARDING REPRODUCTIVE AND FERTILITY 

11 PRESERVATION SERVICES. 

12 The Secretary of Veterans Affairs shall ensure that 

13 employees of the Department of Veterans Affairs assist 

14 veterans— 

15 (1) in navigating the services provided under 

16 this subtitle and the amendments made by this sub17 title; 

18 (2) in finding a provider that meets the needs 

19 of such veterans with respect to such services; and 

20 (3) in continuing the receipt of such services 

21 without interruption if such veterans move to a dif22 ferent geographic location. 


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1 SEC. 214. COORDINATION OF REPRODUCTION AND FER2 TILITY RESEARCH FOR VETERANS. 

3 (a) IN GENERAL.—Subchapter II of chapter 73 of 

4 title 38, United States Code, is amended by adding at the 

5 end the following new section: 

6 ‘‘§ 7330E. Coordination of reproduction and fertility 

7 research for veterans 

8 ‘‘(a) COORDINATION OF RESEARCH REQUIRED.—The 

9 Secretary shall coordinate with the Secretary of Defense 

10 and the Secretary of Health and Human Services to con11 duct research to improve the ability of the Department 

12 of Veterans Affairs to meet the long-term reproductive 

13 health care needs of veterans who have a condition that 

14 affects the ability of the individual to reproduce. 

15 ‘‘(b) DISSEMINATION OF INFORMATION.—The Sec16 retary shall ensure that information produced by the re17 search under this section that may be useful for other ac18 tivities of the Department is disseminated throughout the 

19 Department.’’. 

20 (b) CLERICAL AMENDMENT.—The table of sections 

21 at the beginning of subchapter II of chapter 73 of such 

22 title is amended by inserting after the item relating to sec23 tion 7330D the following new item: 

‘‘7330E. Coordination of reproduction and fertility research for veterans.’’. 


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1 TITLE III—ACCESS TO FER2 TILITY TREATMENT AND 

3 CARE 

4 SEC. 301. SHORT TITLE. 

5 This title may be cited as the ‘‘Access to Fertility 

6 Treatment and Care Act’’. 

7 SEC. 302. STANDARDS RELATING TO BENEFITS FOR FER8 TILITY TREATMENT. 

9 (a) IN GENERAL.— 

10 (1) PHSA.—Part D of title XXVII of the Pub11 lic Health Service Act (42 U.S.C. 300gg–111 et 

12 seq.) is amended by adding at the end the following: 

13 ‘‘SEC. 2799A–11. STANDARDS RELATING TO BENEFITS FOR 

14 FERTILITY TREATMENT. 

15 ‘‘(a) IN GENERAL.—A group health plan or a health 

16 insurance issuer offering group or individual health insur17 ance coverage shall provide coverage for fertility treat18 ment, if such plan or coverage provides coverage for ob19 stetrical services. 

20 ‘‘(b) DEFINITION.—In this section, the term ‘fertility 

21 treatment’ includes the following: 

22 ‘‘(1) Preservation of human oocytes, sperm, or 

23 embryos for later reproductive use. 


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1 ‘‘(2) Artificial insemination, including 

2 intravaginal insemination, intracervical insemination, 

3 and intrauterine insemination. 

4 ‘‘(3) Assisted reproductive technology, including 

5 in vitro fertilization and other treatments or proce6 dures in which reproductive genetic material, such as 

7 oocytes, sperm, fertilized eggs, and embryos, are 

8 handled, when clinically appropriate. 

9 ‘‘(4) Genetic testing of embryos. 

10 ‘‘(5) Medications prescribed or obtained over11 the-counter, as indicated for fertility. 

12 ‘‘(6) Gamete donation. 

13 ‘‘(7) Such other information, referrals, treat14 ments, procedures, medications, laboratory testing, 

15 technologies, and services relating to fertility as the 

16 Secretary determines appropriate. 

17 ‘‘(c) REQUIRED COVERAGE.—A group health plan 

18 and a health insurance issuer offering group or individual 

19 health insurance coverage that includes coverage for ob20 stetrical services shall provide coverage for fertility treat21 ment determined appropriate by the health care provider, 

22 regardless of whether the participant, beneficiary, or en23 rollee receiving such treatment has been diagnosed with 

24 infertility as defined by the American Society for Repro25 ductive Medicine, if the treatment is performed at, or preVerDate Sep 11 2014 01:54 Oct 04, 2024 Jkt 059200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H9643.IH H9643

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1 scribed by, a medical facility that is in compliance with 

2 relevant standards set by an appropriate Federal agency. 

3 ‘‘(d) LIMITATION.—Cost-sharing, including 

4 deductibles and coinsurance, or other limitations for fer5 tility treatment may not be imposed with respect to the 

6 services required to be covered under subsection (c) to the 

7 extent that such cost-sharing exceeds the cost-sharing ap8 plied to other medical services under the group health plan 

9 or health insurance coverage or such other limitations are 

10 different from limitations imposed with respect to such 

11 medical services, except where such limitation is more fa12 vorable with respect to fertility treatment. The Secretary 

13 shall promulgate interim final regulations to carry out this 

14 subsection, notwithstanding the notice and comment re15 quirements of section 553 of title 5, United States Code. 

16 ‘‘(e) PROHIBITIONS.—A group health plan and a 

17 health insurance issuer offering group or individual health 

18 insurance coverage may not— 

19 ‘‘(1) provide incentives (monetary or otherwise) 

20 to a participant, beneficiary, or enrollee to encourage 

21 such participant, beneficiary, or enrollee not to seek 

22 or obtain fertility treatment to which such partici23 pant, beneficiary, or enrollee is entitled under this 

24 section or to providers to induce such providers not 


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1 to provide medically appropriate fertility treatments 

2 to participants, beneficiaries, or enrollees; 

3 ‘‘(2) prohibit a provider from discussing with a 

4 participant, beneficiary, or enrollee fertility treat5 ment relating to this section; 

6 ‘‘(3) penalize or otherwise reduce or limit the 

7 reimbursement of a provider because such provider 

8 provided fertility treatment to a qualified partici9 pant, beneficiary, or enrollee in accordance with this 

10 section; or 

11 ‘‘(4) on the ground prohibited under title VI of 

12 the Civil Rights Act of 1964, title IX of the Edu13 cation Amendments of 1972, the Age Discrimination 

14 Act of 1975, section 504 of the Rehabilitation Act 

15 of 1973, or section 1557 of the Patient Protection 

16 and Affordable Care Act, exclude any individual 

17 from coverage in accordance with this section, or 

18 discriminate against any individual with respect to 

19 such coverage. 

20 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec21 tion shall be construed to require a participant, bene22 ficiary, or enrollee to undergo fertility treatment. 

23 ‘‘(g) NOTICE.—A group health plan and a health in24 surance issuer offering group or individual health insur25 ance coverage shall provide notice to each participant, benVerDate Sep 11 2014 01:54 Oct 04, 2024 Jkt 059200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H9643.IH H9643

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1 eficiary, and enrollee under such plan or coverage regard2 ing the coverage required by this section in accordance 

3 with regulations promulgated by the Secretary. Such no4 tice shall be in writing and prominently positioned in any 

5 literature or correspondence made available or distributed 

6 by the plan or issuer and shall be transmitted— 

7 ‘‘(1) not later than the earlier of— 

8 ‘‘(A) in the first standard mailing made by 

9 the plan or issuer to the participant, bene10 ficiary, or enrollee following the effective date of 

11 such regulations; 

12 ‘‘(B) as part of any yearly informational 

13 packet sent to the participant, beneficiary, or 

14 enrollee; or 

15 ‘‘(C) January 1, 2026; 

16 ‘‘(2) in the case of a participant, beneficiary, or 

17 enrollee not enrolled in the plan or coverage on the 

18 date of transmission under paragraph (1), upon ini19 tial enrollment of such participant, beneficiary, or 

20 enrollee; and 

21 ‘‘(3) on an annual basis after the transmission 

22 under paragraph (1) or (2). 

23 ‘‘(h) LEVEL AND TYPE OF REIMBURSEMENTS.— 

24 Nothing in this section shall be construed to prevent a 

25 group health plan or a health insurance issuer offering 


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1 group or individual health insurance coverage from negoti2 ating the level and type of reimbursement with a provider 

3 for care provided in accordance with this section.’’. 

4 (2) ERISA.— 

5 (A) IN GENERAL.—Subpart B of part 7 of 

6 subtitle B of title I of the Employee Retirement 

7 Income Security Act of 1974 (29 U.S.C. 1185 

8 et seq.) is amended by adding at the end the 

9 following: 

10 ‘‘SEC. 726. STANDARDS RELATING TO BENEFITS FOR FER11 TILITY TREATMENT. 

12 ‘‘(a) IN GENERAL.—A group health plan or a health 

13 insurance issuer offering group health insurance coverage 

14 shall provide coverage for fertility treatment, if such plan 

15 or coverage provides coverage for obstetrical services. 

16 ‘‘(b) DEFINITION.—In this section, the term ‘fertility 

17 treatment’ includes the following: 

18 ‘‘(1) Preservation of human oocytes, sperm, or 

19 embryos for later reproductive use. 

20 ‘‘(2) Artificial insemination, including 

21 intravaginal insemination, intracervical insemination, 

22 and intrauterine insemination. 

23 ‘‘(3) Assisted reproductive technology, including 

24 in vitro fertilization and other treatments or proce25 dures in which reproductive genetic material, such as 


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1 oocytes, sperm, fertilized eggs, and embryos, are 

2 handled, when clinically appropriate. 

3 ‘‘(4) Genetic testing of embryos. 

4 ‘‘(5) Medications prescribed or obtained over5 the-counter, as indicated for fertility. 

6 ‘‘(6) Gamete donation. 

7 ‘‘(7) Such other information, referrals, treat8 ments, procedures, medications, laboratory testing, 

9 technologies, and services relating to fertility as the 

10 Secretary of Health and Human Services determines 

11 appropriate. 

12 ‘‘(c) REQUIRED COVERAGE.—A group health plan 

13 and a health insurance issuer offering group health insur14 ance coverage that includes coverage for obstetrical serv15 ices shall provide coverage for fertility treatment deter16 mined appropriate by the health care provider, regardless 

17 of whether the participant or beneficiary receiving such 

18 treatment has been diagnosed with infertility as defined 

19 by the American Society for Reproductive Medicine, if the 

20 treatment is performed at, or prescribed by, a medical fa21 cility that is in compliance with relevant standards set by 

22 an appropriate Federal agency. 

23 ‘‘(d) LIMITATION.—Cost-sharing, including 

24 deductibles and coinsurance, or other limitations for fer25 tility treatment may not be imposed with respect to the 


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1 services required to be covered under subsection (c) to the 

2 extent that such cost-sharing exceeds the cost-sharing ap3 plied to other medical services under the group health plan 

4 or health insurance coverage or such other limitations are 

5 different from limitations imposed with respect to such 

6 medical services, except where such limitation is more fa7 vorable with respect to fertility treatment. The Secretary 

8 shall promulgate interim final regulations to carry out this 

9 subsection, notwithstanding the notice and comment re10 quirements of section 553 of title 5, United States Code. 

11 ‘‘(e) PROHIBITIONS.—A group health plan and a 

12 health insurance issuer offering group health insurance 

13 coverage may not— 

14 ‘‘(1) provide incentives (monetary or otherwise) 

15 to a participant or beneficiary to encourage such 

16 participant or beneficiary not to seek or obtain fer17 tility treatment to which such participant or bene18 ficiary is entitled under this section or to providers 

19 to induce such providers not to provide medically ap20 propriate fertility treatments to participants or bene21 ficiaries; 

22 ‘‘(2) prohibit a provider from discussing with a 

23 participant or beneficiary fertility treatment relating 

24 to this section; 


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1 ‘‘(3) penalize or otherwise reduce or limit the 

2 reimbursement of a provider because such provider 

3 provided fertility treatment to a qualified participant 

4 or beneficiary in accordance with this section; or 

5 ‘‘(4) on the ground prohibited under title VI of 

6 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 

7 seq.), title IX of the Education Amendments of 1972 

8 (20 U.S.C. 1681 et seq.), the Age Discrimination 

9 Act of 1975 (42 U.S.C. 6101 et seq.), section 504 

10 of the Rehabilitation Act of 1973 (29 U.S.C. 794), 

11 or section 1557 of the Patient Protection and Af12 fordable Care Act (42 U.S.C. 18116), exclude any 

13 individual from coverage in accordance with this sec14 tion, or discriminate against any individual with re15 spect to such coverage. 

16 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec17 tion shall be construed to require a participant or bene18 ficiary to undergo fertility treatment. 

19 ‘‘(g) NOTICE.—A group health plan and a health in20 surance issuer offering group health insurance coverage 

21 shall provide notice to each participant and beneficiary 

22 under such plan or coverage regarding the coverage re23 quired by this section in accordance with regulations pro24 mulgated by the Secretary. Such notice shall be in writing 

25 and prominently positioned in any literature or corVerDate Sep 11 2014 01:54 Oct 04, 2024 Jkt 059200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H9643.IH H9643

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1 respondence made available or distributed by the plan or 

2 issuer and shall be transmitted— 

3 ‘‘(1) not later than the earlier of— 

4 ‘‘(A) in the first standard mailing made by 

5 the plan or issuer to the participant or bene6 ficiary following the effective date of such regu7 lations; 

8 ‘‘(B) as part of any yearly informational 

9 packet sent to the participant or beneficiary; or 

10 ‘‘(C) January 1, 2026; 

11 ‘‘(2) in the case of a participant or beneficiary 

12 not enrolled in the plan or coverage on the date of 

13 transmission under paragraph (1), upon initial en14 rollment of such participant or beneficiary; and 

15 ‘‘(3) on an annual basis after the transmission 

16 under paragraph (1) or (2). 

17 ‘‘(h) LEVEL AND TYPE OF REIMBURSEMENTS.— 

18 Nothing in this section shall be construed to prevent a 

19 group health plan or a health insurance issuer offering 

20 group health insurance coverage from negotiating the level 

21 and type of reimbursement with a provider for care pro22 vided in accordance with this section.’’. 

23 (B) CLERICAL AMENDMENT.—The table of 

24 contents in section 1 of the Employee Retire25 ment Income Security Act of 1974 (29 U.S.C. 


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1 1001 et seq.) is amended by inserting after the 

2 item relating to section 725 the following new 

3 item: 

‘‘Sec. 726. Standards relating to benefits for fertility treatment.’’. 

4 (3) IRC.— 

5 (A) IN GENERAL.—Subchapter B of chap6 ter 100 of the Internal Revenue Code of 1986 

7 is amended by adding at the end the following: 

8 ‘‘SEC. 9826. STANDARDS RELATING TO BENEFITS FOR FER9 TILITY TREATMENT. 

10 ‘‘(a) IN GENERAL.—A group health plan shall pro11 vide coverage for fertility treatment, if such plan provides 

12 coverage for obstetrical services. 

13 ‘‘(b) DEFINITION.—In this section, the term ‘fertility 

14 treatment’ includes the following: 

15 ‘‘(1) Preservation of human oocytes, sperm, or 

16 embryos for later reproductive use. 

17 ‘‘(2) Artificial insemination, including 

18 intravaginal insemination, intracervical insemination, 

19 and intrauterine insemination. 

20 ‘‘(3) Assisted reproductive technology, including 

21 in vitro fertilization and other treatments or proce22 dures in which reproductive genetic material, such as 

23 oocytes, sperm, fertilized eggs, and embryos, are 

24 handled, when clinically appropriate. 

25 ‘‘(4) Genetic testing of embryos. 


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1 ‘‘(5) Medications prescribed or obtained over2 the-counter, as indicated for fertility. 

3 ‘‘(6) Gamete donation. 

4 ‘‘(7) Such other information, referrals, treat5 ments, procedures, medications, laboratory testing, 

6 technologies, and services relating to fertility as the 

7 Secretary of Health and Human Services determines 

8 appropriate. 

9 ‘‘(c) REQUIRED COVERAGE.—A group health plan 

10 that includes coverage for obstetrical services shall provide 

11 coverage for fertility treatment determined appropriate by 

12 the health care provider, regardless of whether the partici13 pant or beneficiary receiving such treatment has been di14 agnosed with infertility as defined by the American Society 

15 for Reproductive Medicine, if the treatment is performed 

16 at, or prescribed by, a medical facility that is in compli17 ance with relevant standards set by an appropriate Fed18 eral agency. 

19 ‘‘(d) LIMITATION.—Cost-sharing, including 

20 deductibles and coinsurance, or other limitations for fer21 tility treatment may not be imposed with respect to the 

22 services required to be covered under subsection (c) to the 

23 extent that such cost-sharing exceeds the cost-sharing ap24 plied to other medical services under the group health plan 

25 or health insurance coverage or such other limitations are 


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1 different from limitations imposed with respect to such 

2 medical services, except where such limitation is more fa3 vorable with respect to fertility treatment. The Secretary 

4 shall promulgate interim final regulations to carry out this 

5 subsection, notwithstanding the notice and comment re6 quirements of section 553 of title 5, United States Code. 

7 ‘‘(e) PROHIBITIONS.—A group health plan may not— 

8 ‘‘(1) provide incentives (monetary or otherwise) 

9 to a participant or beneficiary to encourage such 

10 participant or beneficiary not to seek or obtain fer11 tility treatment to which such participant or bene12 ficiary is entitled under this section or to providers 

13 to induce such providers not to provide medically ap14 propriate fertility treatments to participants or bene15 ficiaries; 

16 ‘‘(2) prohibit a provider from discussing with a 

17 participant or beneficiary fertility treatment relating 

18 to this section; 

19 ‘‘(3) penalize or otherwise reduce or limit the 

20 reimbursement of a provider because such provider 

21 provided fertility treatment to a qualified participant 

22 or beneficiary in accordance with this section; or 

23 ‘‘(4) on the ground prohibited under title VI of 

24 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 

25 seq.), title IX of the Education Amendments of 1972 


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1 (20 U.S.C. 1681 et seq.), the Age Discrimination 

2 Act of 1975 (42 U.S.C. 6101 et seq.), section 504 

3 of the Rehabilitation Act of 1973 (29 U.S.C. 794), 

4 or section 1557 of the Patient Protection and Af5 fordable Care Act (42 U.S.C. 18116), exclude any 

6 individual from coverage in accordance with this sec7 tion, or discriminate against any individual with re8 spect to such coverage. 

9 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec10 tion shall be construed to require a participant or bene11 ficiary to undergo fertility treatment. 

12 ‘‘(g) NOTICE.—A group health plan shall provide no13 tice to each participant and beneficiary under such plan 

14 regarding the coverage required by this section in accord15 ance with regulations promulgated by the Secretary. Such 

16 notice shall be in writing and prominently positioned in 

17 any literature or correspondence made available or distrib18 uted by the plan and shall be transmitted— 

19 ‘‘(1) not later than the earlier of— 

20 ‘‘(A) in the first standard mailing made by 

21 the plan to the participant or beneficiary fol22 lowing the effective date of such regulations; 

23 ‘‘(B) as part of any yearly informational 

24 packet sent to the participant or beneficiary; or 

25 ‘‘(C) January 1, 2026; 


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1 ‘‘(2) in the case of a participant or beneficiary 

2 not enrolled in the plan on the date of transmission 

3 under paragraph (1), upon initial enrollment of such 

4 participant or beneficiary; and 

5 ‘‘(3) on an annual basis after the transmission 

6 under paragraph (1) or (2). 

7 ‘‘(h) LEVEL AND TYPE OF REIMBURSEMENTS.— 

8 Nothing in this section shall be construed to prevent a 

9 group health plan from negotiating the level and type of 

10 reimbursement with a provider for care provided in ac11 cordance with this section.’’. 

12 (B) CLERICAL AMENDMENT.—The table of 

13 sections for subchapter B of chapter 100 of the 

14 Internal Revenue Code of 1986 is amended by 

15 adding at the end the following new item: 

‘‘Sec. 9826. Standards relating to benefits for fertility treatment.’’. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) PHSA.—Section 2724(c) of the Public 

18 Health Service Act (42 U.S.C. 300gg–23(c)) is 

19 amended by striking ‘‘section 2704’’ and inserting 

20 ‘‘sections 2704 and 2799A–11’’. 

21 (2) ERISA.—Section 731(c) of the Employee 

22 Retirement Income Security Act of 1974 (29 U.S.C. 

23 1191(c)) is amended by striking ‘‘section 711’’ and 

24 inserting ‘‘sections 711 and 726’’. 

25 (c) EFFECTIVE DATES.— 


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1 (1) IN GENERAL.—The amendments made by 

2 subsections (a) and (b) shall apply for plan years be3 ginning on or after the date that is 6 months after 

4 the date of enactment of this Act. 

5 (2) COLLECTIVE BARGAINING EXCEPTION.— 

6 (A) IN GENERAL.—In the case of a group 

7 health plan maintained pursuant to one or more 

8 collective bargaining agreements between em9 ployee representatives and one or more employ10 ers ratified before the date of enactment of this 

11 Act, the amendments made by subsection (a) 

12 shall not apply to plan years beginning before 

13 the later of— 

14 (i) the date on which the last collec15 tive bargaining agreements relating to the 

16 plan terminates (determined without re17 gard to any extension thereof agreed to 

18 after the date of enactment of this Act), or 

19 (ii) the date occurring 6 months after 

20 the date of the enactment of this Act. 

21 (B) CLARIFICATION.—For purposes of 

22 subparagraph (A), any plan amendment made 

23 pursuant to a collective bargaining agreement 

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1 section (a) shall not be treated as a termination 

2 of such collective bargaining agreement. 

3 SEC. 303. REQUIREMENT FOR STATE MEDICAID PLANS TO 

4 PROVIDE MEDICAL ASSISTANCE FOR FER5 TILITY TREATMENT. 

6 (a) IN GENERAL.—Section 1905 of the Social Secu7 rity Act (42 U.S.C. 1396d) is amended— 

8 (1) in subsection (a)(4)(C), by inserting 

9 ‘‘(which shall include fertility treatment provided in 

10 accordance with subsection (kk))’’ after ‘‘family 

11 planning services and supplies’’; and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(kk) REQUIREMENTS FOR COVERAGE OF FERTILITY

15 TREATMENT.—For purposes of subsection (a)(4)(C), a 

16 State shall ensure that the medical assistance provided 

17 under the State plan (or waiver of such plan) for fertility 

18 treatment complies with the requirements of section 

19 2799A–11(b) of the Public Health Service Act in the same 

20 manner as such requirements and limitations apply to 

21 health insurance coverage offered by a group health plan 

22 or health insurance issuer.’’. 

23 (b) TECHNICAL AMENDMENT.—Section 1903(a)(5) 

24 of the Social Security Act (42 U.S.C. 1396b(a)(5)) is 

25 amended by inserting ‘‘described in section 


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1 1905(a)(4)(C)’’ after ‘‘family planning services and sup2 plies’’. 

3 (c) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graph (2), the amendments made by this section 

6 shall take effect on October 1, 2025. 

7 (2) DELAY PERMITTED IF STATE LEGISLATION

8 REQUIRED.—In the case of a State plan approved 

9 under title XIX of the Social Security Act which the 

10 Secretary of Health and Human Services determines 

11 requires State legislation (other than legislation ap12 propriating funds) in order for the plan to meet the 

13 additional requirement imposed by this section, the 

14 State plan shall not be regarded as failing to comply 

15 with the requirements of such title solely on the 

16 basis of the failure of the plan to meet such addi17 tional requirement before the first day of the first 

18 calendar quarter beginning after the close of the 

19 first regular session of the State legislature that 

20 ends after the 1-year period beginning with the date 

21 of the enactment of this section. For purposes of the 

22 preceding sentence, in the case of a State that has 

23 a 2-year legislative session, each year of the session 

24 is deemed to be a separate regular session of the 

25 State legislature. 


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1 SEC. 304. MEDICARE COVERAGE OF FERTILITY TREAT2 MENT. 

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) is amended— 

5 (1) in subparagraph (JJ), by inserting ‘‘and’’ 

6 after the semicolon at the end; and 

7 (2) by adding at the end the following new sub8 paragraph: 

9 ‘‘(KK) fertility treatment (as defined in section 

10 2799A–11(b) of the Public Health Service Act);’’. 

11 (b) PAYMENT AND WAIVER OF COINSURANCE.—Sec12 tion 1833(a)(1) of the Social Security Act (42 U.S.C. 

13 1395l(a)(1)) is amended— 

14 (1) by striking ‘‘and’’ before ‘‘(HH)’’; and 

15 (2) by inserting before the semicolon at the end 

16 the following: ‘‘, and (II) with respect to fertility 

17 treatment (as described in section 1861(s)(2)(KK)), 

18 the amount paid shall be equal to 100 percent of the 

19 lesser of the actual charge for the treatment or the 

20 amount determined under the payment basis deter21 mined under section 1848’’. 

22 (c) WAIVER OF APPLICATION OF DEDUCTIBLE.—The 

23 first sentence of section 1833(b) of the Social Security Act 

24 (42 U.S.C. 1395l(b)) is amended— 

25 (1) by striking ‘‘, and (13)’’ and inserting 

26 ‘‘(13)’’; and 


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1 (2) by striking ‘‘1861(n)..’’ and inserting 

2 ‘‘1861(n), and (14) such deductible shall not apply 

3 with respect to fertility treatment (as described in 

4 section 1861(s)(2)(KK)).’’. 

5 (d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 

6 Section 1848(j)(3) of the Social Security Act (42 U.S.C. 

7 1395w–4(j)(3)) is amended by inserting ‘‘(2)(KK),’’ after 

8 ‘‘risk assessment),’’. 

9 (e) CONFORMING AMENDMENT REGARDING COV10 ERAGE.—Section 1862(a)(1)(A) of the Social Security Act 

11 (42 U.S.C. 1395y(a)(1)(A)) is amended— 

12 (1) by striking ‘‘or additional’’ and inserting ‘‘, 

13 additional’’; and 

14 (2) by inserting ‘‘, or fertility treatment (as de15 scribed in section 1861(s)(2)(KK))’’ after 

16 ‘‘1861(ddd)(1))’’. 

17 (f) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply to services furnished on or after 

19 January 1, 2025. 

20 TITLE IV—FAMILY BUILDING 

21 FEHB FAIRNESS 

22 SEC. 401. SHORT TITLE. 

23 This title may be cited as the ‘‘Family Building 

24 FEHB Fairness Act’’. 


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1 SEC. 402. FERTILITY TREATMENT BENEFITS. 

2 (a) IN GENERAL.—Section 8904 of title 5, United 

3 States Code, is amended— 

4 (1) in subsection (a)— 

5 (A) in paragraph (1), by adding at the end 

6 the following: 

7 ‘‘(G) Fertility treatment benefits.’’; and 

8 (B) in paragraph (2)— 

9 (i) by redesignating subparagraph (F) 

10 as subparagraph (G); and 

11 (ii) by inserting after subparagraph 

12 (E) the following: 

13 ‘‘(F) Fertility treatment benefits.’’; and 

14 (2) by adding at the end the following: 

15 ‘‘(c) In this section, the term ‘fertility treatment’ in16 cludes the following: 

17 ‘‘(1) Preservation of human oocytes, sperm, or 

18 embryos for later reproductive use. 

19 ‘‘(2) Artificial insemination, including 

20 intravaginal insemination, intracervical insemination, 

21 and intrauterine insemination. 

22 ‘‘(3) Assisted reproductive technology, including 

23 in vitro fertilization and other treatments or proce24 dures in which reproductive genetic material, such as 

25 oocytes, sperm, fertilized eggs, and embryos, are 

26 handled, when clinically appropriate. 


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1 ‘‘(4) Genetic testing of embryos. 

2 ‘‘(5) Medications prescribed or obtained over3 the-counter, as indicated for fertility. 

4 ‘‘(6) Gamete donation. 

5 ‘‘(7) Such other information, referrals, treat6 ments, procedures, medications, laboratory services, 

7 technologies, and services relating to fertility as the 

8 Director of the Office of Personnel Management, in 

9 coordination with the Secretary of Health and 

10 Human Services, determines appropriate.’’. 

11 (b) EFFECTIVE DATE.—The amendments made by 

12 this section shall take effect on the date that is 1 year 

13 after the date of enactment of this Act. 

Æ 


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