I

107TH CONGRESS

1ST SESSION H. R. 1246

To amend chapter 89 of title 5, United States Code, to provide that any

health benefits plan which provides obstetrical benefits shall be required

also to provide coverage for the diagnosis and treatment of infertility.

IN THE HOUSE OF REPRESENTATIVES

MARCH 27, 2001

Mr. MEEHAN (for himself, Mr. OLVER, Mr. FROST, Mr. WEINER, Mr. SANDERS, Mr. BENTSEN, Mr. BONIOR, Mr. PRICE of North Carolina, Mr. KILDEE, Mr. NADLER, Mr. STARK, Mr. FILNER, Mr. WYNN, Mrs. MINK of

Hawaii, Mr. NCNULTY, Mr. GUTIERREZ, Mr. LANTOS, Mrs.

CHRISTENSEN, Mr. MCGOVERN, Mr. FRANK, Mr. RUSH, Ms. WOOLSEY,

Ms. MCKINNEY, Mr. EVANS, Mr. OWENS, Mr. RANGEL, Ms. NORTON,

Mr. HINCHEY, Ms. CARSON of Indiana, Mr. BAIRD, Mrs. LOWEY, Mr.

DELAHUNT, and Ms. KILPATRICK) introduced the following bill; which

was referred to the Committee on Government Reform

A BILL

To amend chapter 89 of title 5, United States Code, to

provide that any health benefits plan which provides

obstetrical benefits shall be required also to provide coverage for the diagnosis and treatment of infertility.

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

3 SECTION 1. INFERTILITY BENEFITS.

4 Section 8904 of title 5, United States Code, is

5 amended by adding at the end the following:
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1 ‘‘(c)(1) Each health benefits plan described by section

2 8903 or 8903a which provides obstetrical benefits shall

3 also provide coverage for the diagnosis and treatment of

4 infertility, including nonexperimental assisted reproductive

5 technology procedures.

6 ‘‘(2) Under this subsection—

7 ‘‘(A) coverage for the diagnosis or treatment of

8 infertility may not be subject to any copayment or

9 deductible greater than applies with respect to ob10 stetrical benefits under the plan involved; and

11 ‘‘(B) coverage for a procedure described in

12 paragraph (5)(B) shall, in the case of any individual,

13 be required only if—

14 ‘‘(i) such individual has been unable to

15 carry a pregnancy to live birth through less

16 costly, medically appropriate infertility treat17 ments for which such individual has coverage

18 under this chapter;

19 ‘‘(ii) the procedure (including any retrieval

20 incident thereto) is performed at medical facili21 ties that conform to the standards of the Amer22 ican Society for Reproductive Medicine, the So23 ciety for Assisted Reproductive Technology, the

24 American College of Obstetricians and Gyne25 cologists, or any other similar nationally-recog-
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1 nized organization, or a Federal agency that

2 promulgates standards for infertility proce3 dures; and

4 ‘‘(iii) if the services of a laboratory are re5 quired, such laboratory is accredited by the Col6 lege of American Pathologists’ Reproductive

7 Laboratory Accreditation Program or any other

8 similar nationally-recognized program, or a

9 Federal agency performing a similar function.

10 ‘‘(3)(A) Except as provided in subparagraph (B) or

11 (C)—

12 ‘‘(i) coverage for a procedure described in para13 graph (5)(B) may be provided only if the individual

14 involved has not already undergone 4 attempts to

15 achieve a live birth using any such procedures; and

16 ‘‘(ii) coverage for an oocyte retrieval may be

17 provided only if the individual involved has not al18 ready undergone 4 complete oocyte retrievals.

19 ‘‘(B) For purposes of clause (i) of subparagraph

20 (A)—

21 ‘‘(i) if a live birth results from the third at22 tempt (using a procedure described in paragraph

23 (5)(B)), such clause shall be applied by substituting

24 ‘5’ for ‘4’; and
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1 ‘‘(ii) if a live birth results from the fourth at2 tempt (using a procedure described in paragraph

3 (5)(B)), such clause shall be applied by substituting

4 ‘6’ for the otherwise applicable lifetime maximum.

5 ‘‘(C) For purposes of clause (ii) of subparagraph

6 (A)—

7 ‘‘(i) if a live birth results from the third oocyte

8 retrieval, such clause shall be applied by substituting

9 ‘5’ for ‘4’; and

10 ‘‘(ii) if a live birth results from the fourth oo11 cyte retrieval, such clause shall be applied by sub12 stituting ‘6’ for the otherwise applicable lifetime

13 maximum.

14 ‘‘(4) In no event shall this subsection be considered

15 to permit or require coverage—

16 ‘‘(A) if, or to the extent that, the health bene17 fits plan objects to such coverage on the basis of re18 ligious beliefs; or

19 ‘‘(B) in connection with any procedure or treat20 ment, unless rendered by a physician or at the direc21 tion or request of a physician.

22 ‘‘(5) For purposes of this subsection—

23 ‘‘(A) the term ‘infertility’ means—

24 ‘‘(i) the inability to conceive a pregnancy

25 after 12 months of regular sexual relations
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1 without contraception or to carry a pregnancy

2 to a live birth; or

3 ‘‘(ii) the presence of a demonstrated condi4 tion determined by 2 physicians (at least 1 of

5 whom specializes in infertility) to cause infer6 tility; and

7 ‘‘(B) the term ‘nonexperimental assisted repro8 ductive technology procedure’ means in vitro fer9 tilization, gamete intrafallopian transfer, zygote

10 intrafallopian transfer, and any other clinical treat11 ment or procedure the safety and efficacy of which

12 are recognized by the American Society for Repro13 ductive Medicine, the American College of Obstetri14 cians and Gynecologists, or any other similar nation15 ally-recognized organization, or a Federal agency de16 scribed in paragraph (2)(B)(iii).

17 ‘‘(6) The Office shall prescribe any regulations nec18 essary to carry out this subsection.’’.

19 SEC. 2. EFFECTIVE DATE.

20 The amendment made by this Act shall apply with

21 respect to contracts entered into or renewed for any year

22 beginning after the end of the 6-month period beginning

23 on the date of enactment of this Act.

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