ety for Reproductive Medicine, and the American 
Medical Association that affects men and women 
equally. 
(2) According to the Centers for Disease Con-
trol and Prevention, 1 in 8 couples have difficulty 
getting pregnant or sustaining a pregnancy. 
(3) Infertility affects a broad spectrum of pro-
spective parents. No matter what race, religion, sex-
uality, or economic status one is, infertility does not 
discriminate. 
(4) Approximately one-third of infertility is at-
tributed to the female partner, one-third is attrib-
uted to the male partner, and one-third is caused by 
a combination of problems in both partners or is un-
explained. 
(5) Infertility disproportionately affects individ-
uals with particular health complications. For cancer 
patients and others who must undergo treatments 
such as chemotherapy, radiation therapy, hormone 
therapy, or surgery that are likely to harm the re-
productive system and organs, fertility preservation 
becomes necessary. 
(6) Leading causes of infertility include chronic 
conditions and diseases of the endocrine or metabolic 
systems, such as primary ovarian insufficiency, poly-
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cystic ovarian syndrome, endometriosis, thyroid dis-
orders, menstrual cycle defects, autoimmune dis-
orders, hormonal imbalances, testicular disorders, 
and urological health issues. Other causes include 
structural problems or blockages within the repro-
ductive system, exposure to infectious diseases, occu-
pational or environmental hazards, or genetic influ-
ences. 
(7) Recent improvements in therapy and 
cryopreservation make pregnancy possible for more 
people than in past years. 
(8) Like all other diseases, infertility and its 
treatments should be covered by health insurance. 
(9) A 2017 national survey of employer-spon-
sored health plans found that 44 percent of employ-
ers with at least 500 employees did not cover infer-
tility services, and 25 percent of companies with 
20,000 or more employees did not cover infertility 
services. 
(10) States that do not require insurance cov-
erage of assisted reproductive technology have higher 
rates of multiple births. 
(11) The ability to have a family should not be 
denied to anyone on account of a lack of insurance 
coverage for medically necessary treatment. 
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SEC. 3. STANDARDS RELATING TO BENEFITS FOR TREAT-
MENT OF INFERTILITY AND IATROGENIC IN-
FERTILITY. 
(a) IN GENERAL.—Part A of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg et seq.) is amend-
ed by inserting after section 2728 the following: 
‘‘SEC. 2729. STANDARDS RELATING TO BENEFITS FOR 
TREATMENT OF INFERTILITY AND IATRO-
GENIC INFERTILITY. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group or individual health insur-
ance coverage shall ensure that such plan or coverage pro-
vides coverage for— 
‘‘(1) the treatment of infertility, including non-
experimental assisted reproductive technology proce-
dures, if such plan or coverage provides coverage for 
obstetrical services; and 
‘‘(2) the treatment of iatrogenic infertility. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) the term ‘assisted reproductive technology’ 
means treatments or procedures that involve the 
handling of human egg, sperm, and embryo outside 
of the body with the intent of facilitating a preg-
nancy, including in vitro fertilization, egg or embryo 
cryopreservation, egg or embryo donation, and gesta-
tional surrogacy; 
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‘‘(2) the term ‘infertility’ means a disease, de-
fined by the failure to achieve a successful preg-
nancy after 12 months or more, or for women over 
age 35, 6 months or more, of appropriate, timed un-
protected intercourse or therapeutic donor insemina-
tion; and 
‘‘(3) the term ‘iatrogenic infertility’ means an 
impairment of fertility due to surgery, radiation, 
chemotherapy, or other medical treatment. 
‘‘(c) REQUIRED COVERAGE.— 
‘‘(1) COVERAGE FOR INFERTILITY.—Subject to 
paragraph (3), a group health plan and a health in-
surance issuer offering group or individual health in-
surance coverage that includes coverage for obstet-
rical services shall provide coverage for treatment of 
infertility determined appropriate by the treating 
physician, including, as appropriate, ovulation induc-
tion, egg retrieval, sperm retrieval, artificial insemi-
nation, in vitro fertilization, genetic screening, 
intracytoplasmic sperm injection, and any other non- 
experimental treatment, as determined by the Sec-
retary in consultation with appropriate professional 
and patient organizations such as the American So-
ciety for Reproductive Medicine, RESOLVE: The 
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National Infertility Association, and the American 
College of Obstetricians and Gynecologists. 
‘‘(2) 
COVERAGE
FOR
IATROGENIC
INFER-
TILITY.—A group health plan and a health insur-
ance issuer offering group or individual health insur-
ance coverage shall provide coverage for treatment 
of fertility preservation services for individuals who 
undergo medically necessary treatment that may 
cause iatrogenic infertility, as determined by the 
treating physician, including cryopreservation of 
gametes and other procedures, as determined by the 
Secretary, consistent with established medical prac-
tices and professional guidelines published by profes-
sional medical organizations, including the American 
Society for Clinical Oncology and the American Soci-
ety for Reproductive Medicine. 
‘‘(3) LIMITATION ON COVERAGE OF ASSISTED 
REPRODUCTIVE TECHNOLOGY.—A group health plan 
and a health insurance issuer offering group or indi-
vidual health insurance coverage shall provide cov-
erage for assisted reproductive technology as re-
quired under paragraph (1) if— 
‘‘(A) the individual has been unable to 
bring a pregnancy to a live birth through less 
costly infertility treatments, as determined ap-
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propriate by the treating physician, with consid-
eration given to participant’s or beneficiary’s 
specific diagnoses or condition for which cov-
erage is available under the plan or coverage; 
and 
‘‘(B) the treatment is performed at a med-
ical facility that— 
‘‘(i) conforms to the standards of the 
American Society for Reproductive Medi-
cine and the Society for Assisted Repro-
ductive Technology; and 
‘‘(ii) is in compliance with any stand-
ards set by an appropriate Federal agency. 
‘‘(d) LIMITATION.—Cost-sharing, including deduct-
ibles and coinsurance, or other limitations for infertility 
and iatrogenic infertility therapy may not be imposed with 
respect to the services required to be covered under sub-
section (c) to the extent that such cost-sharing exceeds 
the cost-sharing applied to similar services under the 
group health plan or health insurance coverage or such 
other limitations are different from limitations imposed 
with respect to such similar services. 
‘‘(e) PROHIBITIONS.—A group health plan and a 
health insurance issuer offering group or individual health 
insurance coverage may not— 
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‘‘(1) provide incentives (monetary or otherwise) 
to a participant or beneficiary to encourage such 
participant or beneficiary not to be provided infer-
tility or iatrogenic infertility treatments to which 
such participant or beneficiary is entitled under this 
section or to providers to induce such providers not 
to provide such treatments to qualified participants 
or beneficiaries; 
‘‘(2) prohibit a provider from discussing with a 
participant or beneficiary infertility or iatrogenic in-
fertility treatment techniques or medical treatment 
options relating to this section; or 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided infertility or iatrogenic infertility treat-
ments to a qualified participant or beneficiary in ac-
cordance with this section. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require a participant or bene-
ficiary to undergo infertility or iatrogenic infertility ther-
apy. 
‘‘(g) NOTICE.—A group health plan and a health in-
surance issuer offering group or individual health insur-
ance coverage shall provide notice to each participant and 
beneficiary under such plan regarding the coverage re-
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quired by this section in accordance with regulations pro-
mulgated by the Secretary. Such notice shall be in writing 
and prominently positioned in any literature or cor-
respondence made available or distributed by the plan or 
issuer and shall be transmitted— 
‘‘(1) in the next mailing made by the plan or 
issuer to the participant or beneficiary; 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary; or 
‘‘(3) not later than January 1, 2020, 
whichever is earlier. 
‘‘(h) LEVEL
AND TYPE
OF REIMBURSEMENTS.— 
Nothing in this section shall be construed to prevent a 
group health plan or a health insurance issuer offering 
group or individual health insurance coverage from negoti-
ating the level and type of reimbursement with a provider 
for care provided in accordance with this section.’’. 
(b) CONFORMING AMENDMENT.—Section 2724(c) of 
the Public Health Service Act (42 U.S.C. 300gg–23(c)) 
is amended by striking ‘‘section 2704’’ and inserting ‘‘sec-
tions 2704 and 2708’’. 
(c) EFFECTIVE DATES.— 
(1) IN GENERAL.—The amendments made by 
subsections (a) and (b) shall apply for plan years be-
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ginning on or after the date that is 6 months after 
the date of enactment of this Act. 
(2) COLLECTIVE BARGAINING EXCEPTION.— 
(A) IN GENERAL.—In the case of a group 
health plan maintained pursuant to 1 or more 
collective bargaining agreements between em-
ployee representatives and 1 or more employers 
ratified before the date of enactment of this 
Act, the amendments made by subsection (a) 
shall not apply to plan years beginning before 
the later of— 
(i) the date on which the last collec-
tive bargaining agreements relating to the 
plan terminates (determined without re-
gard to any extension thereof agreed to 
after the date of enactment of this Act), or 
(ii) the date occurring 6 months after 
the date of the enactment of this Act. 
(B) CLARIFICATION.—For purposes of 
subparagraph (A), any plan amendment made 
pursuant to a collective bargaining agreement 
relating to the plan which amends the plan sole-
ly to conform to any requirement added by sub-
section (a) shall not be treated as a termination 
of such collective bargaining agreement. 
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SEC. 4. FEDERAL EMPLOYEES HEALTH BENEFITS PRO-
GRAM. 
(a) IN GENERAL.—Section 8902 of title 5, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘(p) COVERAGE FOR DIAGNOSIS AND TREATMENT 
OF INFERTILITY AND IATROGENIC INFERTILITY.— 
‘‘(1) DEFINITIONS.—In this subsection, the 
terms ‘infertility’ and ‘iatrogenic infertility’ have the 
meanings given those terms in section 2729 of the 
Public Health Service Act. 
‘‘(2) REQUIRED COVERAGE.—A contract under 
this chapter shall provide, in a manner consistent 
with section 2729 of the Public Health Service 
Act— 
‘‘(A) coverage for the diagnosis and treat-
ment of infertility, including nonexperimental 
assisted reproductive technology procedures, if 
such contract covers obstetrical benefits; and 
‘‘(B) coverage for the diagnosis and treat-
ment of iatrogenic infertility. 
‘‘(3) COST.—Coverage for the diagnosis or 
treatment of infertility or iatrogenic infertility under 
a health benefits plan described in section 8903 or 
8903a may not be subject to any copayment or de-
ductible greater than the copayment or deductible, 
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respectively, applicable to obstetrical benefits under 
the plan. 
‘‘(4) PREEMPTION.—Subsection (m)(1) shall 
not, with respect to a contract under this chapter, 
prevent the inclusion of any terms that, under para-
graph (2) of this subsection, are required by reason 
of section 2729 of the Public Health Service Act.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to any contract en-
tered into or renewed for a contract year beginning on 
or after the date that is 180 days after the date of enact-
ment of this Act, and any health benefits plan offered 
under such a contract. 
SEC. 5. BENEFITS FOR TREATMENT OF INFERTILITY AND 
IATROGENIC 
INFERTILITY 
UNDER 
THE 
TRICARE PROGRAM. 
(a) IN GENERAL.—Chapter 55 of title 10, United 
States Code, is amended by adding at the end the fol-
lowing new section: 
‘‘§ 1110c. Obstetrical and infertility benefits 
‘‘(a) IN GENERAL.—Any health care plan under this 
chapter shall provide, in a manner consistent with section 
2729 of the Public Health Service Act— 
‘‘(1) coverage for the diagnosis and treatment 
of infertility, including nonexperimental assisted re-
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SEC. 6. TREATMENT OF INFERTILITY AND IATROGENIC IN-
FERTILITY FOR VETERANS AND SPOUSES OR 
PARTNERS OF VETERANS. 
(a) IN GENERAL.—Subchapter II of chapter 17 of 
title 38, United States Code, is amended by adding at the 
end the following new section: 
‘‘§ 1720J. Infertility treatment and counseling for vet-
erans and spouses or partners of veterans 
‘‘(a) IN GENERAL.—The Secretary shall furnish 
treatment for infertility and iatrogenic infertility, includ-
ing through the use of assisted reproductive technology, 
to a veteran or a spouse or partner of a veteran if the 
veteran, and the spouse or partner of the veteran, as appli-
cable, apply jointly for such treatment and counseling 
through a process prescribed by the Secretary for purposes 
of this section. 
‘‘(b) INFERTILITY DEFINED.—In this section, the 
terms ‘infertility’ and ‘iatrogenic infertility’ have the 
meanings given those terms in section 2729 of the Public 
Health Service Act.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is amended 
by inserting after the item relating to section 1720I the 
following new item: 
‘‘1720J. Infertility treatment and counseling for veterans and spouses or part-
ners of veterans.’’. 
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(c) REGULATIONS.—Not later than 18 months after 
the date of the enactment of this Act, the Secretary of 
Veterans Affairs shall prescribe regulations to carry out 
section 1720J of title 38, United States Code, as added 
by subsection (a). 
Æ 
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