I 

115TH CONGRESS 

2D SESSION H. R. 5965 

To require health insurance coverage for the treatment of infertility. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 24, 2018 

Ms. DELAURO introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Oversight and Government Reform, Armed Services, and Veterans’ Affairs, 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 require health insurance coverage for the treatment of 

infertility. 

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 ‘‘Access to Infertility 

5 Treatment and Care Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) Infertility is a medical disease recognized by 

9 the World Health Organization, the American SociVerDate Sep 11 2014 20:21 Jun 05, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5965.IH H5965

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1 ety for Reproductive Medicine, and the American 

2 Medical Association that affects men and women 

3 equally. 

4 (2) According to the Centers for Disease Con5 trol and Prevention, 1 in 8 couples have difficulty 

6 getting pregnant or sustaining a pregnancy. 

7 (3) Infertility affects a broad spectrum of pro8 spective parents. No matter what race, religion, sex9 uality, or economic status one is, infertility does not 

10 discriminate. 

11 (4) Approximately one-third of infertility is at12 tributed to the female partner, one-third is attrib13 uted to the male partner, and one-third is caused by 

14 a combination of problems in both partners or is un15 explained. 

16 (5) Infertility disproportionately affects individ17 uals with particular health complications. For cancer 

18 patients and others who must undergo treatments 

19 such as chemotherapy, radiation therapy, hormone 

20 therapy, or surgery that are likely to harm the re21 productive system and organs, fertility preservation 

22 becomes necessary. 

23 (6) Leading causes of infertility include chronic 

24 conditions and diseases of the endocrine or metabolic 

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1 cystic ovarian syndrome, endometriosis, thyroid dis2 orders, menstrual cycle defects, autoimmune dis3 orders, hormonal imbalances, testicular disorders, 

4 and urological health issues. Other causes include 

5 structural problems or blockages within the repro6 ductive system, exposure to infectious diseases, occu7 pational or environmental hazards, or genetic influ8 ences. 

9 (7) Recent improvements in therapy and 

10 cryopreservation make pregnancy possible for more 

11 people than in past years. 

12 (8) Like all other diseases, infertility and its 

13 treatments should be covered by health insurance. 

14 (9) A 2017 national survey of employer-spon15 sored health plans found that 44 percent of employ16 ers with at least 500 employees did not cover infer17 tility services, and 25 percent of companies with 

18 20,000 or more employees did not cover infertility 

19 services. 

20 (10) States that do not require insurance cov21 erage of assisted reproductive technology have higher 

22 rates of multiple births. 

23 (11) The ability to have a family should not be 

24 denied to anyone on account of a lack of insurance 

25 coverage for medically necessary treatment. 


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1 SEC. 3. STANDARDS RELATING TO BENEFITS FOR TREAT2 MENT OF INFERTILITY AND IATROGENIC IN3 FERTILITY. 

4 (a) IN GENERAL.—Part A of title XXVII of the Pub5 lic Health Service Act (42 U.S.C. 300gg et seq.) is amend6 ed by inserting after section 2728 the following: 

7 ‘‘SEC. 2729. STANDARDS RELATING TO BENEFITS FOR 

8 TREATMENT OF INFERTILITY AND IATRO9 GENIC INFERTILITY. 

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

11 insurance issuer offering group or individual health insur12 ance coverage shall ensure that such plan or coverage pro13 vides coverage for— 

14 ‘‘(1) the treatment of infertility, including non15 experimental assisted reproductive technology proce16 dures, if such plan or coverage provides coverage for 

17 obstetrical services; and 

18 ‘‘(2) the treatment of iatrogenic infertility. 

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

20 ‘‘(1) the term ‘assisted reproductive technology’ 

21 means treatments or procedures that involve the 

22 handling of human egg, sperm, and embryo outside 

23 of the body with the intent of facilitating a preg24 nancy, including in vitro fertilization, egg or embryo 

25 cryopreservation, egg or embryo donation, and gesta26 tional surrogacy; 


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1 ‘‘(2) the term ‘infertility’ means a disease, de2 fined by the failure to achieve a successful preg3 nancy after 12 months or more, or for women over 

4 age 35, 6 months or more, of appropriate, timed un5 protected intercourse or therapeutic donor insemina6 tion; and 

7 ‘‘(3) the term ‘iatrogenic infertility’ means an 

8 impairment of fertility due to surgery, radiation, 

9 chemotherapy, or other medical treatment. 

10 ‘‘(c) REQUIRED COVERAGE.— 

11 ‘‘(1) COVERAGE FOR INFERTILITY.—Subject to 

12 paragraph (3), a group health plan and a health in13 surance issuer offering group or individual health in14 surance coverage that includes coverage for obstet15 rical services shall provide coverage for treatment of 

16 infertility determined appropriate by the treating 

17 physician, including, as appropriate, ovulation induc18 tion, egg retrieval, sperm retrieval, artificial insemi19 nation, in vitro fertilization, genetic screening, 

20 intracytoplasmic sperm injection, and any other non21 experimental treatment, as determined by the Sec22 retary in consultation with appropriate professional 

23 and patient organizations such as the American So24 ciety for Reproductive Medicine, RESOLVE: The 


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1 National Infertility Association, and the American 

2 College of Obstetricians and Gynecologists. 

3 ‘‘(2) COVERAGE FOR IATROGENIC INFER4 TILITY.—A group health plan and a health insur5 ance issuer offering group or individual health insur6 ance coverage shall provide coverage for treatment 

7 of fertility preservation services for individuals who 

8 undergo medically necessary treatment that may 

9 cause iatrogenic infertility, as determined by the 

10 treating physician, including cryopreservation of 

11 gametes and other procedures, as determined by the 

12 Secretary, consistent with established medical prac13 tices and professional guidelines published by profes14 sional medical organizations, including the American 

15 Society for Clinical Oncology and the American Soci16 ety for Reproductive Medicine. 

17 ‘‘(3) LIMITATION ON COVERAGE OF ASSISTED

18 REPRODUCTIVE TECHNOLOGY.—A group health plan 

19 and a health insurance issuer offering group or indi20 vidual health insurance coverage shall provide cov21 erage for assisted reproductive technology as re22 quired under paragraph (1) if— 

23 ‘‘(A) the individual has been unable to 

24 bring a pregnancy to a live birth through less 

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1 propriate by the treating physician, with consid2 eration given to participant’s or beneficiary’s 

3 specific diagnoses or condition for which cov4 erage is available under the plan or coverage; 

5 and 

6 ‘‘(B) the treatment is performed at a med7 ical facility that— 

8 ‘‘(i) conforms to the standards of the 

9 American Society for Reproductive Medi10 cine and the Society for Assisted Repro11 ductive Technology; and 

12 ‘‘(ii) is in compliance with any stand13 ards set by an appropriate Federal agency. 

14 ‘‘(d) LIMITATION.—Cost-sharing, including deduct15 ibles and coinsurance, or other limitations for infertility 

16 and iatrogenic infertility therapy may not be imposed with 

17 respect to the services required to be covered under sub18 section (c) to the extent that such cost-sharing exceeds 

19 the cost-sharing applied to similar services under the 

20 group health plan or health insurance coverage or such 

21 other limitations are different from limitations imposed 

22 with respect to such similar services. 

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

24 health insurance issuer offering group or individual health 

25 insurance coverage may not— 


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

2 to a participant or beneficiary to encourage such 

3 participant or beneficiary not to be provided infer4 tility or iatrogenic infertility treatments to which 

5 such participant or beneficiary is entitled under this 

6 section or to providers to induce such providers not 

7 to provide such treatments to qualified participants 

8 or beneficiaries; 

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

10 participant or beneficiary infertility or iatrogenic in11 fertility treatment techniques or medical treatment 

12 options relating to this section; or 

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

14 reimbursement of a provider because such provider 

15 provided infertility or iatrogenic infertility treat16 ments to a qualified participant or beneficiary in ac17 cordance with this section. 

18 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec19 tion shall be construed to require a participant or bene20 ficiary to undergo infertility or iatrogenic infertility ther21 apy. 

22 ‘‘(g) NOTICE.—A group health plan and a health in23 surance issuer offering group or individual health insur24 ance coverage shall provide notice to each participant and 

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1 quired by this section in accordance with regulations pro2 mulgated by the Secretary. Such notice shall be in writing 

3 and prominently positioned in any literature or cor4 respondence made available or distributed by the plan or 

5 issuer and shall be transmitted— 

6 ‘‘(1) in the next mailing made by the plan or 

7 issuer to the participant or beneficiary; 

8 ‘‘(2) as part of any yearly informational packet 

9 sent to the participant or beneficiary; or 

10 ‘‘(3) not later than January 1, 2020, 

11 whichever is earlier. 

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

13 Nothing in this section shall be construed to prevent a 

14 group health plan or a health insurance issuer offering 

15 group or individual health insurance coverage from negoti16 ating the level and type of reimbursement with a provider 

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

18 (b) CONFORMING AMENDMENT.—Section 2724(c) of 

19 the Public Health Service Act (42 U.S.C. 300gg–23(c)) 

20 is amended by striking ‘‘section 2704’’ and inserting ‘‘sec21 tions 2704 and 2708’’. 

22 (c) EFFECTIVE DATES.— 

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

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1 ginning on or after the date that is 6 months after 

2 the date of enactment of this Act. 

3 (2) COLLECTIVE BARGAINING EXCEPTION.— 

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

5 health plan maintained pursuant to 1 or more 

6 collective bargaining agreements between em7 ployee representatives and 1 or more employers 

8 ratified before the date of enactment of this 

9 Act, the amendments made by subsection (a) 

10 shall not apply to plan years beginning before 

11 the later of— 

12 (i) the date on which the last collec13 tive bargaining agreements relating to the 

14 plan terminates (determined without re15 gard to any extension thereof agreed to 

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

17 (ii) the date occurring 6 months after 

18 the date of the enactment of this Act. 

19 (B) CLARIFICATION.—For purposes of 

20 subparagraph (A), any plan amendment made 

21 pursuant to a collective bargaining agreement 

22 relating to the plan which amends the plan sole23 ly to conform to any requirement added by sub24 section (a) shall not be treated as a termination 

25 of such collective bargaining agreement. 


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1 SEC. 4. FEDERAL EMPLOYEES HEALTH BENEFITS PRO2 GRAM. 

3 (a) IN GENERAL.—Section 8902 of title 5, United 

4 States Code, is amended by adding at the end the fol5 lowing: 

6 ‘‘(p) COVERAGE FOR DIAGNOSIS AND TREATMENT

7 OF INFERTILITY AND IATROGENIC INFERTILITY.— 

8 ‘‘(1) DEFINITIONS.—In this subsection, the 

9 terms ‘infertility’ and ‘iatrogenic infertility’ have the 

10 meanings given those terms in section 2729 of the 

11 Public Health Service Act. 

12 ‘‘(2) REQUIRED COVERAGE.—A contract under 

13 this chapter shall provide, in a manner consistent 

14 with section 2729 of the Public Health Service 

15 Act— 

16 ‘‘(A) coverage for the diagnosis and treat17 ment of infertility, including nonexperimental 

18 assisted reproductive technology procedures, if 

19 such contract covers obstetrical benefits; and 

20 ‘‘(B) coverage for the diagnosis and treat21 ment of iatrogenic infertility. 

22 ‘‘(3) COST.—Coverage for the diagnosis or 

23 treatment of infertility or iatrogenic infertility under 

24 a health benefits plan described in section 8903 or 

25 8903a may not be subject to any copayment or de26 ductible greater than the copayment or deductible, 


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1 respectively, applicable to obstetrical benefits under 

2 the plan. 

3 ‘‘(4) PREEMPTION.—Subsection (m)(1) shall 

4 not, with respect to a contract under this chapter, 

5 prevent the inclusion of any terms that, under para6 graph (2) of this subsection, are required by reason 

7 of section 2729 of the Public Health Service Act.’’. 

8 (b) EFFECTIVE DATE.—The amendment made by 

9 subsection (a) shall apply with respect to any contract en10 tered into or renewed for a contract year beginning on 

11 or after the date that is 180 days after the date of enact12 ment of this Act, and any health benefits plan offered 

13 under such a contract. 

14 SEC. 5. BENEFITS FOR TREATMENT OF INFERTILITY AND 

15 IATROGENIC INFERTILITY UNDER THE 

16 TRICARE PROGRAM. 

17 (a) IN GENERAL.—Chapter 55 of title 10, United 

18 States Code, is amended by adding at the end the fol19 lowing new section: 

20 ‘‘§ 1110c. Obstetrical and infertility benefits 

21 ‘‘(a) IN GENERAL.—Any health care plan under this 

22 chapter shall provide, in a manner consistent with section 

23 2729 of the Public Health Service Act— 

24 ‘‘(1) coverage for the diagnosis and treatment 

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1 productive technology procedures, if such plan covers 

2 obstetrical benefits; and 

3 ‘‘(2) coverage for the diagnosis and treatment 

4 of iatrogenic infertility. 

5 ‘‘(b) COPAYMENT.—The Secretary of Defense shall 

6 establish cost-sharing requirements for the coverage of di7 agnosis and treatment of infertility and iatrogenic infer8 tility described in subsection (a) that are consistent with 

9 the cost-sharing requirements applicable to health plans 

10 and health insurance coverage under section 2729(d) of 

11 the Public Health Service Act. 

12 ‘‘(c) REGULATIONS.—The Secretary of Defense shall 

13 prescribe any regulations necessary to carry out this sec14 tion. 

15 ‘‘(d) DEFINITIONS.—In this section, the terms ‘infer16 tility’ and ‘iatrogenic infertility’ have the meanings given 

17 those terms in section 2729 of the Public Health Service 

18 Act.’’. 

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

20 at the beginning of chapter 55 of such title is amended 

21 by adding at the end the following new item: 

‘‘1110c. Obstetrical and infertility benefits.’’. 


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1 SEC. 6. TREATMENT OF INFERTILITY AND IATROGENIC IN2 FERTILITY FOR VETERANS AND SPOUSES OR 

3 PARTNERS OF VETERANS. 

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

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

6 end the following new section: 

7 ‘‘§ 1720J. Infertility treatment and counseling for vet8 erans and spouses or partners of veterans 

9 ‘‘(a) IN GENERAL.—The Secretary shall furnish 

10 treatment for infertility and iatrogenic infertility, includ11 ing through the use of assisted reproductive technology, 

12 to a veteran or a spouse or partner of a veteran if the 

13 veteran, and the spouse or partner of the veteran, as appli14 cable, apply jointly for such treatment and counseling 

15 through a process prescribed by the Secretary for purposes 

16 of this section. 

17 ‘‘(b) INFERTILITY DEFINED.—In this section, the 

18 terms ‘infertility’ and ‘iatrogenic infertility’ have the 

19 meanings given those terms in section 2729 of the Public 

20 Health Service Act.’’. 

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

22 at the beginning of chapter 17 of such title is amended 

23 by inserting after the item relating to section 1720I the 

24 following new item: 

‘‘1720J. Infertility treatment and counseling for veterans and spouses or partners of veterans.’’. 


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1 (c) REGULATIONS.—Not later than 18 months after 

2 the date of the enactment of this Act, the Secretary of 

3 Veterans Affairs shall prescribe regulations to carry out 

4 section 1720J of title 38, United States Code, as added 

5 by subsection (a). 

Æ 


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