I
106TH CONGRESS
1ST SESSION
H. R. 2774
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
AUGUST 5, 1999
Mr. MEEHAN 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 cov-
erage for the diagnosis and treatment of infertility.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. INFERTILITY BENEFITS.
Section 8904 of title 5, United States Code, is
amended by adding at the end the following:
‘‘(c)(1) Each health benefits plan described by section
8903 or 8903a which provides obstetrical benefits shall
also provide coverage for the diagnosis and treatment of
infertility, including nonexperimental assisted reproductive
technology procedures.
‘‘(2) Under this subsection—
‘‘(A) coverage for the diagnosis or treatment of
infertility may not be subject to any copayment or
deductible greater than applies with respect to ob-
stetrical benefits under the plan involved; and
‘‘(B) coverage for a procedure described in
paragraph (5)(B) shall, in the case of any individual,
be required only if—
‘‘(i) such individual has been unable to
carry a pregnancy to live birth through less
costly, medically appropriate infertility treat-
ments for which such individual has coverage
under this chapter;
‘‘(ii) the procedure (including any retrieval
incident thereto) is performed at medical facili-
ties that conform to the standards of the Amer-
ican Society for Reproductive Medicine, the So-
ciety for Assisted Reproductive Technology, the
American College of Obstetricians and Gyne-
cologists, or any other similar nationally-recog-
nized organization, or a Federal agency that
promulgates standards for infertility proce-
dures; and
‘‘(iii) if the services of a laboratory are re-
quired, such laboratory is accredited by the Col-
lege of American Pathologists’ Reproductive
Laboratory Accreditation Program or any other
similar nationally-recognized program, or a
Federal agency performing a similar function.
‘‘(3)(A) Except as provided in subparagraph (B) or
(C)—
‘‘(i) coverage for a procedure described in para-
graph (5)(B) may be provided only if the individual
involved has not already undergone 4 attempts to
achieve a live birth using any such procedures; and
‘‘(ii) coverage for an oocyte retrieval may be
provided only if the individual involved has not al-
ready undergone 4 complete oocyte retrievals.
‘‘(B) For purposes of clause (i) of subparagraph
(A)—
‘‘(i) if a live birth results from the third at-
tempt (using a procedure described in paragraph
(5)(B)), such clause shall be applied by substituting
‘5’ for ‘4’; and
‘‘(ii) if a live birth results from the fourth at-
tempt (using a procedure described in paragraph
(5)(B)), such clause shall be applied by substituting
‘6’ for the otherwise applicable lifetime maximum.
‘‘(C) For purposes of clause (ii) of subparagraph
(A)—
‘‘(i) if a live birth results from the third oocyte
retrieval, such clause shall be applied by substituting
‘5’ for ‘4’; and
‘‘(ii) if a live birth results from the fourth oo-
cyte retrieval, such clause shall be applied by sub-
stituting ‘6’ for the otherwise applicable lifetime
maximum.
‘‘(4) In no event shall this subsection be considered
to permit or require coverage—
‘‘(A) if, or to the extent that, the health bene-
fits plan objects to such coverage on the basis of re-
ligious beliefs; or
‘‘(B) in connection with any procedure or treat-
ment, unless rendered by a physician or at the direc-
tion or request of a physician.
‘‘(5) For purposes of this subsection—
‘‘(A) the term ‘infertility’ means—
‘‘(i) the inability to conceive a pregnancy
after 12 months of regular sexual relations
without contraception or to carry a pregnancy
to a live birth; or
‘‘(ii) the presence of a demonstrated condi-
tion determined by 2 physicians (at least 1 of
whom specializes in infertility) to cause infer-
tility; and
‘‘(B) the term ‘nonexperimental assisted repro-
ductive technology procedure’ means in vitro fer-
tilization, gamete intrafallopian transfer, zygote
intrafallopian transfer, and any other clinical treat-
ment or procedure the safety and efficacy of which
are recognized by the American Society for Repro-
ductive Medicine, the American College of Obstetri-
cians and Gynecologists, or any other similar nation-
ally-recognized organization, or a Federal agency de-
scribed in paragraph (2)(B)(iii).
‘‘(6) The Office shall prescribe any regulations nec-
essary to carry out this subsection.’’.
SEC. 2. EFFECTIVE DATE.
The amendment made by this Act shall apply with
respect to contracts entered into or renewed for any year
beginning after the end of the 6-month period beginning
on the date of enactment of this Act.
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