I 

118TH CONGRESS 

2D SESSION H. R. 8821 

To ensure coverage for the treatment of infertility for certain conditions. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 25, 2024 

Mrs. CHAVEZ-DEREMER (for herself, Mr. NUNN of Iowa, Ms. WILD, and Ms. 

WASSERMAN SCHULTZ) introduced the following bill; which was referred 

to the Committee on Education and the Workforce 

A BILL 

To ensure coverage for the treatment of infertility for certain 

conditions. 

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. 

4 This Act may be cited as the ‘‘Helping to Optimize 

5 Patients’ Experience with Fertility Services Act’’ or the 

6 ‘‘HOPE with Fertility Services Act’’. 

7 SEC. 2. ENSURING BENEFITS FOR TREATMENT OF INFER8 TILITY AND IATROGENIC INFERTILITY. 

9 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

10 B of title I of the Employee Retirement Income Security 


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1 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by in2 serting after section 714 the following: 

3 ‘‘SEC. 714A. STANDARDS RELATING TO BENEFITS FOR 

4 TREATMENT OF INFERTILITY AND IATRO5 GENIC INFERTILITY. 

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

7 insurance issuer offering group health insurance coverage 

8 shall ensure that such plan or coverage provides coverage 

9 for infertility or iatrogenic infertility treatments, includ10 ing— 

11 ‘‘(1) the treatment of infertility, if such plan or 

12 coverage provides coverage for obstetrical services; 

13 and 

14 ‘‘(2) standard fertility preservation services 

15 when a medically necessary treatment described in 

16 subparagraph (A), (B), (C), or (D) of subsection 

17 (b)(1) causes, or is expected to cause, iatrogenic in18 fertility. 

19 ‘‘(b) DEFINITIONS.—In this section: 

20 ‘‘(1) IATROGENIC INFERTILITY.—The term ‘iat21 rogenic infertility’ means an impairment of fertility 

22 due to damage of reproductive organs and processes 

23 resulting from— 

24 ‘‘(A) a surgical or other invasive medical 

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1 ening illness, or involving a reproductive organ 

2 or process in a manner likely to cause damage 

3 to such organ or process; 

4 ‘‘(B) radiation therapy; 

5 ‘‘(C) chemotherapy; or 

6 ‘‘(D) myeloablative conditioning. 

7 ‘‘(2) INFERTILITY.—The term ‘infertility’ 

8 means a disease or condition characterized by— 

9 ‘‘(A) the inability to achieve spontaneous 

10 pregnancy without medical treatment after a 

11 period of at least 12 consecutive months of un12 protected sexual intercourse; 

13 ‘‘(B) the inability to achieve pregnancy 

14 after receiving standard clinical treatment pro15 tocols under the supervision of a treating physi16 cian who is a board-certified reproductive 

17 endocrinologist or obstetrician-gynecologist; 

18 ‘‘(C) being incapable of reproduction to 

19 live birth based on medical and reproductive 

20 history, age, physical findings or diagnostic 

21 testing of the individual, as determined by a 

22 treating physician; or 

23 ‘‘(D) the inability to achieve spontaneous 

24 pregnancy on account of a diagnosed condition 


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1 that is a disorder of ovulation, or a testicular 

2 or hormonal disease or disorder. 

3 ‘‘(3) INFERTILITY OR IATROGENIC INFERTILITY

4 TREATMENT.—The term ‘infertility or iatrogenic in5 fertility treatment’ means treatments or procedures 

6 with the intent of facilitating a pregnancy, includ7 ing— 

8 ‘‘(A) such treatments or procedures that 

9 involve the handling of human egg, sperm, and 

10 embryo outside of the body, including in vitro 

11 fertilization and maturation, egg and embryo 

12 cryopreservation, egg and embryo donation, and 

13 intracytoplasmic sperm injection; or 

14 ‘‘(B) such treatments or procedures that 

15 do not involve the handling of human egg, 

16 sperm, and embryo outside of the body, includ17 ing ovulation induction, genetic screening and 

18 diagnosis, sperm cryopreservation, and intra19 uterine insemination. 

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

21 and a health insurance issuer offering group health insur22 ance coverage that includes coverage for obstetrical serv23 ices shall provide comprehensive coverage for infertility or 

24 iatrogenic infertility treatments, as determined by the SecVerDate Sep 11 2014 20:28 Sep 20, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8821.IH H8821

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1 retary in consultation with relevant stakeholders, provided 

2 to a participant or beneficiary if— 

3 ‘‘(1) the participant or beneficiary has infer4 tility, including iatrogenic infertility; and 

5 ‘‘(2) the treatment or service is performed at a 

6 medical facility that is in compliance with standards 

7 set by appropriate Federal and State agencies. 

8 ‘‘(d) FINANCIAL REQUIREMENTS AND TREATMENT

9 REQUIREMENTS.—Any coverage provided by a group 

10 health plan or health insurance issuer in accordance with 

11 this section may be subject to coverage limits (such as 

12 medical necessity, pre-authorization, or pre-certification) 

13 and cost-sharing requirements (such as coinsurance, co14 payments, and deductibles), as required under the group 

15 health plan or health insurance coverage, that are no more 

16 restrictive than the predominant coverage limits and cost17 sharing requirements applied to substantially all medical 

18 and surgical benefits covered under the plan or coverage. 

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

20 health insurance issuer offering group health insurance 

21 coverage may not— 

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

23 to a participant or beneficiary to encourage such 

24 participant or beneficiary not to be provided infer25 tility or iatrogenic infertility treatments to which 


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1 such participant or beneficiary is entitled under this 

2 section, or to providers to induce such providers not 

3 to provide such treatments to qualified participants 

4 and beneficiaries; 

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

6 participant or beneficiary infertility or iatrogenic in7 fertility treatments or medical treatment options re8 quired to be covered under this section; or 

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

10 reimbursement of a provider because such provider 

11 provided infertility or iatrogenic infertility treatment 

12 services to a participant or beneficiary in accordance 

13 with this section. 

14 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to— 

16 ‘‘(1) require a participant or beneficiary in a 

17 group health plan or group health insurance cov18 erage to undergo infertility or iatrogenic infertility 

19 treatments; 

20 ‘‘(2) impact the use by a group health plan or 

21 a health insurance issuer offering group health in22 surance coverage of utilization management tools; or 

23 ‘‘(3) prevent a group health plan or a health in24 surance issuer offering group health insurance cov25 erage from contracting with providers as to the level 


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1 and type of reimbursement with a provider for care 

2 provided in accordance with this section. 

3 ‘‘(g) UTILIZATION MANAGEMENT TOOLS REQUIRE4 MENTS.— 

5 ‘‘(1) IN GENERAL.—In the case of a group 

6 health plan or a health insurance issuer offering 

7 group health insurance coverage that imposes utili8 zation management tools on infertility and iatrogenic 

9 infertility treatment benefits, for the first 5 plan 

10 years that begin after the date of enactment of the 

11 Helping to Optimize Patients’ Experience with Fer12 tility Services Act, such plan or issuer shall perform 

13 and document analyses of the design and application 

14 of the utilization management tool such analysis and 

15 the following information: 

16 ‘‘(A) The specific plan or coverage terms 

17 or other relevant terms regarding the utilization 

18 management tools and a description of all infer19 tility or iatrogenic infertility treatment benefits, 

20 to which each such term applies in each respec21 tive benefits classification. 

22 ‘‘(B) The factors used to determine that 

23 the utilization management tool will apply to in24 fertility or iatrogenic infertility treatment bene25 fits. 


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1 ‘‘(C) The evidentiary standards used for 

2 the factors identified under subparagraph (B), 

3 when applicable, provided that every factor shall 

4 be defined, and any other source or evidence re5 lied upon to design and apply the utilization 

6 management tool to infertility and iatrogenic 

7 infertility treatment benefits. 

8 ‘‘(D) An analysis demonstrating that the 

9 processes, strategies, evidentiary standards, and 

10 other factors used to apply the utilization man11 agement tools to infertility and iatrogenic infer12 tility treatment benefits as written and in oper13 ation, are consistent with, and are applied no 

14 more stringently than with clinical guidelines 

15 for infertility or iatrogenic infertility treat16 ments. 

17 ‘‘(E) The specific findings and conclusions 

18 reached by the group health plan or health in19 surance issuer with respect to the health insur20 ance coverage, including any results of the anal21 yses described in this paragraph that indicate 

22 that the plan or coverage is or is not in compli23 ance with this section. 

24 ‘‘(2) SUBMISSION PROCESS.— 


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1 ‘‘(A) ANNUAL SUBMISSION.—A group 

2 health plan or health insurance issuer offering 

3 group health insurance coverage shall submit to 

4 the Secretary the analyses described in para5 graph (1) annually for first 5 plan years that 

6 begin after the date of enactment of the Help7 ing to Optimize Patients’ Experience with Fer8 tility Services Act. For subsequent plan years, 

9 the Secretary may request that a group health 

10 plan or a health insurance issuer offering group 

11 health insurance coverage submit the analysis 

12 described in paragraph (1) in the case of poten13 tial violations of this section or complaints re14 garding noncompliance with this section that 

15 concern utilization management tools and any 

16 other instances in which the Secretary deter17 mines appropriate. 

18 ‘‘(B) ADDITIONAL INFORMATION.—If the 

19 Secretary concludes that a group health plan or 

20 health insurance issuer has not submitted suffi21 cient information for the Secretary to review 

22 the analysis described in paragraph (1), the 

23 Secretary shall specify to the plan or issuer the 

24 information the plan or issuer is required to 

25 submit pursuant to subparagraph (A). Nothing 


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1 in this subparagraph shall require the Secretary 

2 to conclude that a group health plan or health 

3 insurance issuer is in compliance with this sec4 tion solely based upon the inspection of the 

5 analyses described in paragraph (1), as re6 quested under subparagraph (A). 

7 ‘‘(3) REQUIRED ACTION.— 

8 ‘‘(A) IN GENERAL.—If, after review of the 

9 analyses described in paragraph (1), the Sec10 retary notifies the group health plan or health 

11 insurance issuer that such plan or issuer is not 

12 in compliance with this section, the plan or 

13 issuer— 

14 ‘‘(i) shall specify to the Secretary the 

15 actions the plan or issuer will take to be in 

16 compliance with this section and provide to 

17 the Secretary additional analyses described 

18 in paragraph (1) that demonstrate compli19 ance with this section not later than 45 

20 days after the initial notification by the 

21 Secretary that the plan or issuer is not in 

22 compliance; and 

23 ‘‘(ii) following the 45-day corrective 

24 action period under clause (i), if the Sec25 retary makes a final determination that 


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1 the plan or issuer still is not in compliance 

2 with this section, not later than 7 days 

3 after such determination, shall notify all 

4 individuals enrolled in the applicable plan 

5 or health insurance coverage that such 

6 plan or coverage has been determined to be 

7 not in compliance with this section. 

8 ‘‘(B) EXEMPTION FROM DISCLOSURE.— 

9 Documents or communications produced in con10 nection with the Secretary’s recommendations 

11 to a group health plan or health insurance 

12 issuer shall not be subject to disclosure pursu13 ant to section 552 of title 5, United States 

14 Code. 

15 ‘‘(4) REPORT.—For plan years beginning on or 

16 after January 1, 2026, the Secretary shall submit to 

17 Congress, and make publicly available, a report that 

18 contains— 

19 ‘‘(A) a summary of the analysis submitted 

20 under paragraph (1), including the identity of 

21 each group health plan or health insurance 

22 issuer offering health insurance coverage that is 

23 determined to be not in compliance after the 

24 final determination by the Secretary described 

25 in paragraph (3)(A)(ii); 


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1 ‘‘(B) the Secretary’s conclusions as to 

2 whether each group health plan or health insur3 ance issuer submitted sufficient information for 

4 the Secretary to review the analysis under para5 graph (2); 

6 ‘‘(C) for each group health plan or health 

7 insurance issuer that did submit sufficient in8 formation under paragraph (2), the Secretary’s 

9 conclusions as to whether and why the plan or 

10 issuer is in compliance with the requirements 

11 under this section; 

12 ‘‘(D) the Secretary’s specifications de13 scribed in paragraph (3) for each group health 

14 plan or health insurance issuer that the Sec15 retary determined did not submit sufficient in16 formation for the Secretary to review the anal17 yses described in paragraph (1) for compliance 

18 with this section; and 

19 ‘‘(E) the actions the Secretary specifies 

20 under paragraph (3)(A)(i) that each group 

21 health plan or health insurance issuer that the 

22 Secretary determined is not in compliance with 

23 this section is required take to be in compliance 

24 with this section, including the reason why the 


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1 Secretary determined the plan or issuer is not 

2 in compliance. 

3 ‘‘(h) NOTICE.—Beginning with the second plan year 

4 beginning after the date of enactment of the Helping to 

5 Optimize Patients’ Experience with Fertility Services Act, 

6 a group health plan and a health insurance issuer offering 

7 group health insurance coverage shall provide notice to 

8 participants and beneficiaries in such plan or coverage re9 garding the coverage required by this section in accord10 ance with regulations promulgated by the Secretary. 

11 ‘‘(i) EFFECTIVE DATE.—This section, and the 

12 amendments made by this section, shall apply with respect 

13 to plan years beginning on or after January 1, 2026.’’. 

14 (b) ENFORCEMENT.—Section 502 of the Employee 

15 Retirement Income Security Act of 1974 (29 U.S.C. 1132) 

16 is amended— 

17 (1) in subsection (a)(6), by striking ‘‘or (9)’’ 

18 and inserting ‘‘(9), or (13)’’; 

19 (2) in subsection (b)(3), by striking ‘‘subsection 

20 (c)(9)’’ and inserting ‘‘paragraphs (9) and (13) of 

21 subsection (c)’’; and 

22 (3) in subsection (c), by adding at the end the 

23 following: 

24 ‘‘(13)(A) The Secretary may assess a civil penalty 

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1 erage for infertility or iatrogenic infertility treatments as 

2 required under section 714A, in an amount up to $100 

3 per day, beginning on the date on which the issuer first 

4 denies such coverage and ending on the date on which the 

5 issuer approves coverage, with respect to each participant 

6 or beneficiary denied such coverage in violation of such 

7 section. 

8 ‘‘(B) The Secretary may assess a civil penalty against 

9 a health insurance issuer for failing to submit an analysis 

10 as required under section 714A(g)(2), in an amount up 

11 to $100 for each day, beginning 45 days after the date 

12 on which the Secretary notifies such issuer that the issuer 

13 is not in compliance with the requirement under section 

14 714A(g)(2), and ending on the date on which the issue 

15 submits the analysis as required.’’. 

16 (c) CONFORMING AMENDMENT.—Section 731(c) of 

17 the Employee Retirement Income Security Act of 1974 

18 (29 U.S.C. 1191(c)) is amended by striking ‘‘section 711’’ 

19 and inserting ‘‘sections 711 and 714A’’. 

Æ 


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