II

106TH CONGRESS

2D SESSION S. 2160

To require health plans to include infertility benefits, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MARCH 2, 2000

Mr. TORRICELLI introduced the following bill; which was read twice and

referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To require health plans to include infertility benefits, and

for other purposes.

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 ‘‘Fair Access to Infer5 tility Treatment and Hope Act of 2000’’.

6 SEC. 2. FINDINGS.

7 Congress finds that—

8 (1) infertility affects 6,100,000 men and

9 women;

10 (2) infertility is a disease which affects men

11 and women with equal frequency;
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1 (3) approximately 1 in 10 couples cannot con2 ceive without medical assistance;

3 (4) recent medical breakthroughs make infer4 tility a treatable disease; and

5 (5) only 25 percent of all health plan sponsors

6 provide coverage for infertility services.

7 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN8 COME SECURITY ACT OF 1974.

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

10 B of title I of the Employee Retirement Income Security

11 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add12 ing at the end the following:

13 ‘‘SEC. 714. REQUIRED COVERAGE FOR INFERTILITY BENE14 FITS.

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

16 health insurance issuer providing health insurance cov17 erage in connection with a group health plan, shall ensure

18 that coverage is provided for infertility benefits.

19 ‘‘(b) INFERTILITY BENEFITS.—In subsection (a), the

20 term ‘infertility benefits’ at a minimum includes—

21 ‘‘(1) diagnostic testing and treatment of infer22 tility;

23 ‘‘(2) drug therapy, artificial insemination, and

24 low tubal ovum transfers;
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1 ‘‘(3) in vitro fertilization, intra-cytoplasmic

2 sperm injection, gamete donation, embryo donation,

3 assisted hatching, embryo transfer, gamete intra-fal4 lopian tube transfer, zygote intra-fallopian tube

5 transfer; and

6 ‘‘(4) any other medically indicated nonexperi7 mental services or procedures that are used to treat

8 infertility or induce pregnancy.

9 ‘‘(c) IN VITRO FERTILIZATION.—

10 ‘‘(1) LIMITATION.—

11 ‘‘(A) IN GENERAL.—Subject to subpara12 graph (B), coverage of procedures under sub13 section (b)(3) may be limited to 4 completed

14 embryo transfers.

15 ‘‘(B) ADDITIONAL TRANSFERS.—If a live

16 birth follows a completed embryo transfer under

17 a procedure described in subparagraph (A), not

18 less than 2 additional completed embryo trans19 fers shall be provided.

20 ‘‘(2) REQUIREMENT.—Coverage of procedures

21 under subsection (b)(3) shall be provided if—

22 ‘‘(A) the individual has been unable to at23 tain or sustain a successful pregnancy through

24 reasonable, less costly medically appropriate

25 covered infertility treatments; and
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1 ‘‘(B) the procedures are performed at med2 ical facilities that conform with the minimal

3 guidelines and standards for assisted reproduc4 tive technology of the American College of Ob5 stetric and Gynecology or the American Society

6 for Reproductive Medicine.

7 ‘‘(d) PROHIBITIONS.—A group health plan, and a

8 health insurance issuer providing health insurance cov9 erage in connection with a group health plan, may not—

10 ‘‘(1) deny to an individual eligibility, or contin11 ued eligibility, to enroll or to renew coverage under

12 the terms of the plan because of the individual’s or

13 enrollee’s use or potential use of items or services

14 that are covered in accordance with the requirements

15 of this section;

16 ‘‘(2) provide monetary payments or rebates to

17 a covered individual to encourage such individual to

18 accept less than the minimum protections available

19 under this section; or

20 ‘‘(3) provide incentives (monetary or otherwise)

21 to a health care professional to induce such profes22 sional to withhold from a covered individual services

23 described in subsection (a).

24 ‘‘(e) RULES OF CONSTRUCTION.—
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1 ‘‘(1) IN GENERAL.—Nothing in this section

2 shall be construed—

3 ‘‘(A) as preventing a group health plan

4 and a health insurance issuer providing health

5 insurance coverage in connection with a group

6 health plan from imposing deductibles, coinsur7 ance, or other cost-sharing or limitations in re8 lation to benefits for services described in this

9 section under the plan, except that such a de10 ductible, coinsurance, or other cost-sharing or

11 limitation for any such service may not be

12 greater than such a deductible, coinsurance, or

13 cost-sharing or limitation for any similar service

14 otherwise covered under the plan;

15 ‘‘(B) as requiring a group health plan and

16 a health insurance issuer providing health in17 surance coverage in connection with a group

18 health plan to cover experimental or investiga19 tional treatments of services described in this

20 section, except to the extent that the plan or

21 issuer provides coverage for other experimental

22 or investigational treatments or services.

23 ‘‘(2) LIMITATIONS.—As used in paragraph (1),

24 the term ‘limitation’ includes restricting the type of
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1 health care professionals that may provide such

2 treatments or services.

3 ‘‘(f) NOTICE UNDER GROUP HEALTH PLAN.—The

4 imposition of the requirements of this section shall be

5 treated as a material modification in the terms of the plan

6 described in section 102(a)(1), for purposes of assuring

7 notice of such requirements under the plan, except that

8 the summary description required to be provided under the

9 last sentence of section 104(b)(1) with respect to such

10 modification shall be provided by not later than 60 days

11 after the first day of the first plan year in which such

12 requirements apply.’’.

13 (b) CLERICAL AMENDMENT.—The table of contents

14 in section 1 of the Employee Retirement Income Security

15 Act of 1974 (29 U.S.C. 1001 note) is amended by insert16 ing after the item relating to section 713 the following

17 new item:

‘‘Sec. 714. Required coverage for infertility benefits for federal employees health

benefits plans.’’.

18 (c) EFFECTIVE DATE.—The amendments made by

19 this section shall apply with respect to plan years begin20 ning on or after January 1, 2001.

21 SEC. 4. PUBLIC HEALTH SERVICE ACT.

22 (a) IN GENERAL.—Subpart 2 of part A of title

23 XXVII of the Public Health Service Act (42 U.S.C.
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1 300gg–4 et seq.) is amended by adding at the end the

2 following:

3 ‘‘SEC. 2707. REQUIRED COVERAGE FOR INFERTILITY BENE4 FITS.

5 ‘‘(a) IN GENERAL.—A group health plan, and a

6 health insurance issuer providing health insurance cov7 erage in connection with a group health plan, shall ensure

8 that coverage is provided for infertility benefits.

9 ‘‘(b) INFERTILITY BENEFITS.—In subsection (a), the

10 term ‘infertility benefits’ at a minimum includes—

11 ‘‘(1) diagnostic testing and treatment of infer12 tility;

13 ‘‘(2) drug therapy, artificial insemination, and

14 low tubal ovum transfers;

15 ‘‘(3) in vitro fertilization, intra-cytoplasmic

16 sperm injection, gamete donation, embryo donation,

17 assisted hatching, embryo transfer, gamete intra-fal18 lopian tube transfer, zygote intra-fallopian tube

19 transfer; and

20 ‘‘(4) any other medically indicated nonexperi21 mental services or procedures that are used to treat

22 infertility or induce pregnancy.

23 ‘‘(c) IN VITRO FERTILIZATION.—

24 ‘‘(1) LIMITATION.—
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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), coverage of procedures under sub3 section (b)(3) may be limited to 4 completed

4 embryo transfers.

5 ‘‘(B) ADDITIONAL TRANSFERS.—If a live

6 birth follows a completed embryo transfer under

7 a procedure described in subparagraph (A), not

8 less than 2 additional completed embryo trans9 fers shall be provided.

10 ‘‘(2) REQUIREMENT.—Coverage of procedures

11 under subsection (b)(3) shall be provided if—

12 ‘‘(A) the individual has been unable to at13 tain or sustain a successful pregnancy through

14 reasonable, less costly medically appropriate

15 covered infertility treatments; and

16 ‘‘(B) the procedures are performed at med17 ical facilities that conform with the minimal

18 guidelines and standards for assisted reproduc19 tive technology of the American College of Ob20 stetric and Gynecology or the American Society

21 for Reproductive Medicine.

22 ‘‘(d) PROHIBITIONS.—A group health plan, and a

23 health insurance issuer providing health insurance cov24 erage in connection with a group health plan, may not—
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1 ‘‘(1) deny to an individual eligibility, or contin2 ued eligibility, to enroll or to renew coverage under

3 the terms of the plan because of the individual’s or

4 enrollee’s use or potential use of items or services

5 that are covered in accordance with the requirements

6 of this section;

7 ‘‘(2) provide monetary payments or rebates to

8 a covered individual to encourage such individual to

9 accept less than the minimum protections available

10 under this section; or

11 ‘‘(3) provide incentives (monetary or otherwise)

12 to a health care professional to induce such profes13 sional to withhold from a covered individual services

14 described in subsection (a).

15 ‘‘(e) RULES OF CONSTRUCTION.—

16 ‘‘(1) IN GENERAL.—Nothing in this section

17 shall be construed—

18 ‘‘(A) as preventing a group health plan

19 and a health insurance issuer providing health

20 insurance coverage in connection with a group

21 health plan from imposing deductibles, coinsur22 ance, or other cost-sharing or limitations in re23 lation to benefits for services described in this

24 section under the plan, except that such a de25 ductible, coinsurance, or other cost-sharing or
10

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1 limitation for any such service may not be

2 greater than such a deductible, coinsurance, or

3 cost-sharing or limitation for any similar service

4 otherwise covered under the plan;

5 ‘‘(B) as requiring a group health plan and

6 a health insurance issuer providing health in7 surance coverage in connection with a group

8 health plan to cover experimental or investiga9 tional treatments of services described in this

10 section, except to the extent that the plan or

11 issuer provides coverage for other experimental

12 or investigational treatments or services.

13 ‘‘(2) LIMITATIONS.—As used in paragraph (1),

14 the term ‘limitation’ includes restricting the type of

15 health care professionals that may provide such

16 treatments or services.

17 ‘‘(f) NOTICE UNDER GROUP HEALTH PLAN.—The

18 imposition of the requirements of this section shall be

19 treated as a material modification in the terms of the plan

20 described in section 102(a)(1), for purposes of assuring

21 notice of such requirements under the plan, except that

22 the summary description required to be provided under the

23 last sentence of section 104(b)(1) with respect to such

24 modification shall be provided by not later than 60 days
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1 after the first day of the first plan year in which such

2 requirements apply.’’.

3 (b) INDIVIDUAL MARKET.—Part B of title XXVII of

4 the Public Health Service Act (42 U.S.C. 300gg–41 et

5 seq.) is amended—

6 (1) by redesignating the first subpart 3 (relat7 ing to other requirements) as subpart 2; and

8 (2) by adding at the end of subpart 2 the fol9 lowing new section:

10 ‘‘SEC. 2753. REQUIRED COVERAGE FOR INFERTILITY BENE11 FITS.

12 ‘‘The provisions of section 2707 shall apply to health

13 insurance coverage offered by a health insurance issuer

14 in the individual market in the same manner as they apply

15 to health insurance coverage offered by a health insurance

16 issuer in connection with a group health plan in the small

17 or large group market.’’.

18 (c) EFFECTIVE DATE.—The amendments made by

19 this section shall apply with respect to health insurance

20 coverage offered, sold, issued, renewed, in effect, or oper21 ated on or after January 1, 2001.
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1 SEC. 5. REQUIRED COVERAGE FOR INFERTILITY BENEFITS

2 FOR FEDERAL EMPLOYEES HEALTH BENE3 FITS PLANS.

4 (a) TYPES OF BENEFITS.—Section 8904(a)(1) of

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

6 end the following:

7 ‘‘(G) Infertility benefits.’’.

8 (b) HEALTH BENEFITS PLAN CONTRACT REQUIRE9 MENT.—Section 8902 of title 5, United States Code, is

10 amended by adding at the end the following:

11 ‘‘(p)(1) Each contract under this chapter shall in12 clude a provision that ensures infertility benefits as pro13 vided under this subsection.

14 ‘‘(2) Infertility benefits under this subsection shall

15 include—

16 ‘‘(A) diagnostic testing and treatment of infer17 tility;

18 ‘‘(B) drug therapy, artificial insemination, and

19 low tubal ovum transfers;

20 ‘‘(C) in vitro fertilization, intra-cytoplasmic

21 sperm injection, gamete donation, embryo donation,

22 assisted hatching, embryo transfer, gamete intra-fal23 lopian tube transfer, zygote intra-fallopian tube

24 transfer; and
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1 ‘‘(D) any other medically indicated nonexperi2 mental services or procedures that are used to treat

3 infertility or induce pregnancy.

4 ‘‘(3)(A)(i) Subject to clause (ii), procedures under

5 paragraph (2)(C) shall be limited to 4 completed embryo

6 transfers.

7 ‘‘(ii) If a live birth follows a completed embryo trans8 fer, 2 additional completed embryo transfers shall be pro9 vided.

10 ‘‘(B) Procedures under paragraph (2)(C) shall be

11 provided if—

12 ‘‘(i) the individual has been unable to attain or

13 sustain a successful pregnancy through reasonable,

14 less costly medically appropriate covered infertility

15 treatments; and

16 ‘‘(ii) the procedures are performed at medical

17 facilities that conform with the minimal guidelines

18 and standards for assisted reproductive technology

19 of the American College of Obstetric and Gynecology

20 or the American Society for Reproductive Medi21 cine.’’.

22 (c) EFFECTIVE DATE.—The amendments made by

23 this section shall apply to contract years beginning on or

24 after January 1, 2001.

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