I 
117TH CONGRESS 
1ST SESSION H. R. 4450 
To require health insurance coverage for the treatment of infertility. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 16, 2021 
Ms. DELAURO (for herself, Mr. CONNOLLY, Ms. ROSS, Ms. LEE of California, 
and Mr. CLEAVER) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Commit-
tees on Oversight and Reform, Armed Services, and Veterans’ Affairs, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To require health insurance coverage for the 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. SHORT TITLE. 
This Act may be cited as the ‘‘Access to Infertility 
Treatment and Care Act’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
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(1) Infertility is a medical disease recognized by 
the World Health Organization, the American Soci-
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-
ual orientation, or economic status one is, infertility 
does not discriminate. 
(4) According to the Centers for Disease Con-
trol and Prevention, 11 percent of women in the 
United States between the ages of 15 and 44 have 
difficulty getting pregnant or staying pregnant. 
Similarly, 9 percent of men in the United States be-
tween the ages of 15 and 44 experience infertility. 
(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. 
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(6) Leading causes of infertility include chronic 
conditions and diseases of the endocrine or metabolic 
systems, such as primary ovarian insufficiency, poly-
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) Coverage for infertility services under 
State Medicaid programs is limited. The Medicaid 
programs of only 5 States provide diagnostic testing 
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for women and men in all of their program eligibility 
pathways; the Medicaid program of only one State 
provides coverage for certain medications for women 
experiencing infertility; and no State Medicaid pro-
grams cover intrauterine insemination or in vitro 
fertilization. 
(11) States that do not require private insur-
ance coverage of assisted reproductive technology 
have higher rates of multiple births. 
(12) The ability to have a family should not be 
denied to anyone on account of a lack of insurance 
coverage for medically necessary treatment. 
SEC. 3. STANDARDS RELATING TO BENEFITS FOR TREAT-
MENT OF INFERTILITY AND PREVENTION OF 
IATROGENIC INFERTILITY. 
(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 2729 the following: 
‘‘SEC. 2729A. STANDARDS RELATING TO BENEFITS FOR 
TREATMENT OF INFERTILITY AND PREVEN-
TION OF IATROGENIC 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— 
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‘‘(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) standard fertility preservation services 
when a medically necessary treatment may directly 
or indirectly cause 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, embryo, 
or sperm cryopreservation, egg or embryo donation, 
and gestational surrogacy; 
‘‘(2) the term ‘infertility’ means a disease, char-
acterized by the failure to establish a clinical preg-
nancy— 
‘‘(A) after 12 months of regular, unpro-
tected sexual intercourse; or 
‘‘(B) due to a person’s incapacity for re-
production either as an individual or with his or 
her partner, which may be determined after a 
period of less than 12 months of regular, un-
protected sexual intercourse, or based on med-
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ical, sexual and reproductive history, age, phys-
ical findings, or diagnostic testing; 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 
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-
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ance coverage shall provide coverage of fertility pres-
ervation services for individuals who undergo medi-
cally necessary treatment that may cause iatrogenic 
infertility, as determined by the treating physician, 
including cryopreservation of gametes and other pro-
cedures, as determined by the Secretary, consistent 
with established medical practices and professional 
guidelines published by professional medical organi-
zations, including the American Society of Clinical 
Oncology and the American Society 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 is unable to bring a 
pregnancy to a live birth through minimally 
invasive infertility treatments, as determined 
appropriate by the treating physician, with con-
sideration given to participant’s or beneficiary’s 
specific diagnoses or condition for which cov-
erage is available under the plan or coverage; 
and 
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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 treatments or 
fertility preservation technology or medical treat-
ment options relating to this section; or 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided infertility treatments or fertility preserva-
tion services to a qualified participant or beneficiary 
in accordance 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 treatments or fertility preser-
vation services. 
‘‘(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-
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— 
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‘‘(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, 2022, 
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-
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 one or more 
collective bargaining agreements between em-
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ployee representatives and one or more employ-
ers 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. 
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: 
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‘‘(q)(1) In this subsection, the terms ‘infertility’ and 
‘iatrogenic infertility’ have the meanings given those terms 
in section 2729A of the Public Health Service Act. 
‘‘(2) A contract under this chapter shall provide, in 
a manner consistent with section 2729A of the Public 
Health Service Act, coverage for— 
‘‘(A) the diagnosis and treatment of infertility, 
including 
nonexperimental 
assisted 
reproductive 
technology procedures, if that contract covers obstet-
rical benefits; and 
‘‘(B) standard fertility preservation services 
when a medically necessary treatment may directly 
or indirectly cause iatrogenic infertility. 
‘‘(3) Coverage for the diagnosis or treatment of infer-
tility and fertility preservation services under a health ben-
efits plan described in section 8903 or 8903a may not be 
subject to any copayment or deductible greater than the 
copayment or deductible, respectively, applicable to obstet-
rical benefits under the plan. 
‘‘(4) Subsection (m)(1) shall not, with respect to a 
contract under this chapter, prevent the inclusion of any 
terms that, under paragraph (2) of this subsection, are 
required by reason of section 2729A of the Public Health 
Service Act.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to— 
(1) any contract entered into or renewed for a 
contract year beginning on or after the date that is 
180 days after the date of enactment of this Act; 
and 
(2) any health benefits plan offered under a 
contract described in paragraph (1). 
SEC. 5. BENEFITS FOR TREATMENT OF INFERTILITY AND 
PREVENTION OF 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 
2729A of the Public Health Service Act— 
‘‘(1) coverage for the diagnosis and treatment 
of infertility, including nonexperimental assisted re-
productive technology procedures, if such plan covers 
obstetrical benefits; and 
‘‘(2) coverage for standard fertility preservation 
services when a medically necessary treatment may 
directly or indirectly cause iatrogenic infertility. 
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‘‘(b) COPAYMENT.—The Secretary of Defense shall 
establish cost-sharing requirements for the coverage of di-
agnosis and treatment of infertility and fertility preserva-
tion services described in subsection (a) that are consistent 
with the cost-sharing requirements applicable to health 
plans and health insurance coverage under section 
2729A(d) of the Public Health Service Act. 
‘‘(c) REGULATIONS.—The Secretary of Defense shall 
prescribe any regulations necessary to carry out this sec-
tion. 
‘‘(d) DEFINITIONS.—In this section, the terms ‘as-
sisted reproductive technology’, ‘iatrogenic infertility’, and 
‘infertility’ have the meanings given those terms in section 
2729A of the Public Health Service Act.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 55 of such title is amended 
by adding at the end the following new item: 
‘‘1110c. Obstetrical and infertility benefits.’’. 
SEC. 6. TREATMENT OF INFERTILITY AND PREVENTION OF 
IATROGENIC INFERTILITY 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: 
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‘‘§ 1720K. Infertility treatment for veterans and 
spouses or partners of veterans 
‘‘(a) IN GENERAL.—The Secretary shall furnish 
treatment for infertility and fertility preservation services, 
including through the use of assisted reproductive tech-
nology, to a veteran or a spouse or partner of a veteran 
if the veteran, and the spouse or partner of the veteran, 
as applicable, apply jointly for such treatment through a 
process prescribed by the Secretary for purposes of this 
section. 
‘‘(b) DEFINITIONS.—In this section, the terms ‘as-
sisted reproductive technology’ and ‘infertility’ have the 
meanings given those terms in section 2729A of the Public 
Health Service Act.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of subchapter II of chapter 17 of such 
title is amended by inserting after the item relating to sec-
tion 1720J the following new item: 
‘‘1720K. Infertility treatment for veterans and spouses or partners of vet-
erans.’’. 
(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 1720K of title 38, United States Code, as added 
by subsection (a). 
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SEC. 7. REQUIREMENT FOR STATE MEDICAID PLANS TO 
PROVIDE MEDICAL ASSISTANCE FOR TREAT-
MENT OF INFERTILITY AND PREVENTION OF 
IATROGENIC INFERTILITY. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)(4)— 
(A) by striking ‘‘; and (D)’’ and inserting 
‘‘; (D)’’; 
(B) by striking ‘‘; and (E)’’ and inserting 
‘‘; (E)’’; 
(C) by striking ‘‘; and (F)’’ and inserting 
‘‘; (F)’’; and 
(D) by inserting before the semicolon at 
the end the following: ‘‘; and (G) services and 
supplies to treat infertility and prevent iatro-
genic infertility (as such terms are defined in 
section 2729A(b) of the Public Health Service 
Act) in accordance with subsection (jj)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(jj) REQUIREMENTS
FOR COVERAGE
OF INFER-
TILITY TREATMENT AND PREVENTION OF IATROGENIC 
INFERTILITY.—For purposes of subsection (a)(4)(G), a 
State shall ensure that the medical assistance provided 
under the State plan (or waiver of such plan) for treat-
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ment of infertility and fertility preservation services com-
plies with the requirements and limitations of section 
2729A(c) of the Public Health Service Act in the same 
manner as such requirements and limitations apply to 
health insurance coverage offered by a group health plan 
or health insurance issuer.’’. 
(b) NO COST SHARING FOR INFERTILITY TREAT-
MENT.— 
(1) IN GENERAL.—Subsections (a)(2)(D) and 
(b)(2)(D) of section 1916 of the Social Security Act 
(42 U.S.C. 1396o(a)(2)(D)) are amended by insert-
ing ‘‘, services and supplies to treat infertility and 
provide fertility preservation services described in 
section 1905(a)(4)(G)’’ after ‘‘1905(a)(4)(C)’’ each 
place it appears. 
(2) APPLICATION TO ALTERNATIVE COST SHAR-
ING.—Section 1916A(b)(3)(B)(vii) of the Social Se-
curity Act (42 U.S.C. 1396o–1(b)(3)(B)(vii)) is 
amended by inserting ‘‘and services and supplies to 
treat infertility and provide fertility preservation de-
scribed in section 1905(a)(4)(G)’’ before the period. 
(c) PRESUMPTIVE ELIGIBILITY
FOR INFERTILITY 
TREATMENT.—Section 1920C of the Social Security Act 
(42 U.S.C. 1396r–1c) is amended— 
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(1) in the section heading, by inserting ‘‘AND 
INFERTILITY TREATMENT’’ after ‘‘FAMILY PLANNING 
SERVICES’’; and 
(2) in subsection (a)— 
(A) by striking ‘‘State plan’’ and inserting 
‘‘A State plan’’; 
(B) by striking ‘‘1905(a)(4)(C)’’ and in-
serting ‘‘section 1905(a)(4)(C), services and 
supplies to treat infertility and prevent iatro-
genic 
infertility 
described 
in 
section 
1905(a)(4)(G),’’; and 
(C) by inserting ‘‘or in conjunction with an 
infertility treatment service in an infertility 
treatment setting’’ before the period. 
(d) INCLUSION IN BENCHMARK COVERAGE.—Section 
1937(b) of the Social Security Act (42 U.S.C. 1396u– 
7(b)) is amended by adding at the end the following new 
paragraph: 
‘‘(9) COVERAGE OF INFERTILITY TREATMENT 
AND PREVENTION OF IATROGENIC INFERTILITY.— 
Notwithstanding the previous provisions of this sec-
tion, a State may not provide for medical assistance 
through enrollment of an individual with benchmark 
coverage or benchmark-equivalent coverage under 
this section unless such coverage includes medical 
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assistance for services and supplies to treat infer-
tility and provide fertility preservation described in 
section 1905(a)(4)(G) in accordance with such sec-
tion.’’. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall take effect on October 1, 2021. 
(2) DELAY PERMITTED IF STATE LEGISLATION 
REQUIRED.—In the case of a State plan approved 
under title XIX of the Social Security Act which the 
Secretary of Health and Human Services determines 
requires State legislation (other than legislation ap-
propriating funds) in order for the plan to meet the 
additional requirement imposed by this section, the 
State plan shall not be regarded as failing to comply 
with the requirements of such title solely on the 
basis of the failure of the plan to meet such addi-
tional requirement before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that 
ends after the 1-year period beginning with the date 
of the enactment of this section. For purposes of the 
preceding sentence, in the case of a State that has 
a 2-year legislative session, each year of the session 
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is deemed to be a separate regular session of the 
State legislature. 
Æ 
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