SEC. 2. INCLUDING FERTILITY TREATMENT AND CARE AS 
AN ESSENTIAL HEALTH BENEFIT. 
(a) IN GENERAL.—Section 1302(b) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(b)) 
is amended— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘paragraph (2)’’ and inserting 
‘‘paragraphs (2) and (6)’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(K) Fertility treatment and care.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) FERTILITY
TREATMENT
AND
CARE
DE-
FINED.—For purposes of paragraph (1)(K), the 
term ‘fertility treatment and care’ means the fol-
lowing medically appropriate items and services fur-
nished to an individual: 
‘‘(A) Preservation of human oocytes, 
sperm, or embryos for later reproductive use. 
‘‘(B) Artificial insemination, including 
intravaginal insemination, intracervical insemi-
nation, and intrauterine insemination. 
‘‘(C) Assisted reproductive technology, in-
cluding in vitro fertilization and other treat-
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB
ments or procedures in which reproductive ge-
netic material, such as oocytes, sperm, fertilized 
eggs, and embryos, are handled, when clinically 
appropriate, and including at least 3 complete 
oocyte retrievals and an unlimited number of 
embryo transfers from such retrievals (regard-
less of whether such retrieval was performed on, 
before, or after the date of the enactment of 
this paragraph) in accordance with the guide-
lines of the American Society for Reproductive 
Medicine and using single embryo transfer 
when recommended and medically appropriate. 
‘‘(D) Genetic testing of embryos. 
‘‘(E) Medications prescribed, as indicated 
for fertility. 
‘‘(F) Gamete donation. 
‘‘(G) Such other information, referrals, 
treatments, procedures, medications, laboratory 
testing, technologies, and services relating to 
fertility as the Secretary determines appro-
priate.’’. 
(b) ADDITIONAL REQUIREMENTS.—Subpart II of 
part A of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–11 et seq.) is amended by adding at 
the end the following new section: 
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘SEC. 2730. REQUIREMENTS RELATING TO FERTILITY 
TREATMENT AND CARE. 
‘‘(a) IN GENERAL.—In the case of health insurance 
coverage offered in the individual or small group market 
that provides both medical and surgical benefits and bene-
fits for fertility treatment and care (as defined in section 
1302(b) of the Patient Protection and Affordable Care 
Act), such coverage shall ensure that— 
‘‘(1) the financial requirements applicable to 
such fertility treatment and care benefits are no 
more restrictive than the predominant financial re-
quirements applied to substantially all medical and 
surgical benefits covered by the coverage, and there 
are no separate cost sharing requirements that are 
applicable only with respect to fertility treatment 
and care benefits; and 
‘‘(2) the treatment limitations applicable to 
such fertility treatment and care benefits are no 
more restrictive than the predominant treatment 
limitations applied to substantially all medical and 
surgical benefits covered by the coverage and there 
are no separate treatment limitations that are appli-
cable only with respect to fertility treatment and 
care benefits. 
‘‘(b) PROHIBITION ON DENIAL OF CARE.—A health 
insurance issuer offering health insurance coverage in the 
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB
individual or small group market may not deny benefits 
for fertility treatment and care for individual on the basis 
that such individual lacks a diagnosis of infertility. 
‘‘(c) UTILIZATION MANAGEMENT TOOLS.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
offering health insurance coverage in the individual 
or small group market that imposes any utilization 
management tool with respect to fertility treatment 
and care shall, for each of the first 5 plan years be-
ginning on or after the date that is 1 year after the 
date of the enactment of this Act (and, upon request 
of the Secretary or the Comptroller General of the 
United States, for any subsequent plan year), con-
duct an analysis of the application of any such tool 
to such treatment and care and submit such analysis 
to the Secretary and to the Comptroller General of 
the United States. Such analysis shall contain the 
following information: 
‘‘(A) The specific coverage terms or other 
relevant terms regarding the application of such 
tools to such benefits and a description of all 
such benefits. 
‘‘(B) The factors used to determine when 
utilization management tools apply to such ben-
efits. 
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(C) The evidentiary standards used in de-
signing the application of such tools with re-
spect to such benefits and any other source or 
evidence used to determine the application of 
such tools to such benefits. 
‘‘(D) Information demonstrating how ap-
plication of such tools to such benefits are con-
sistent with clinical guidelines for fertility treat-
ment and care. 
‘‘(E) Any findings by the issuer that such 
coverage is not in compliance with this section. 
‘‘(2) REPORT.—For plan years beginning on or 
after the date that is 1 year after the date of the 
enactment of this section, the Comptroller General 
of the United States shall submit to Congress and 
make publicly available a report that contains the 
following: 
‘‘(A) A summary of the analyses submitted 
under paragraph (1) with respect to such plan 
year. 
‘‘(B) An identification of each health in-
surance issuer that failed to submit an analysis 
under paragraph (1). 
‘‘(C) With respect to each health insurance 
issuer that did submit such an analysis, a speci-
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB
fication as to whether such issuer submitted in-
formation sufficient to determine whether such 
issuer was in compliance with such require-
ments. 
‘‘(D) For each health insurance issuer that 
did submit information sufficient to determine 
such compliance, a finding of whether such 
issuer was in compliance with such require-
ments. 
‘‘(d) DEFINITIONS.—The terms ‘financial require-
ment’, ‘predominant’, and ‘treatment limitation’ have the 
meaning given such terms in section 2726(a)(3).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to plan years beginning on or after 
the date that is 1 year after the date of the enactment 
of this Act. 
Æ 
VerDate Sep 11 2014 
02:18 May 22, 2025
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6301
E:\BILLS\H3480.IH
H3480
kjohnson on DSK7ZCZBW3PROD with $$_JOB