‘‘(B) as part of any yearly informational 
packet sent to the participant, beneficiary, or 
enrollee; or 
‘‘(C) January 1, 2027; 
‘‘(2) in the case of a participant, beneficiary, or 
enrollee not enrolled in the plan or coverage on the 
date of transmission under paragraph (1), upon ini-
tial enrollment of such participant, beneficiary, or 
enrollee; and 
‘‘(3) on an annual basis after the transmission 
under paragraph (1) or (2). 
‘‘(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.’’. 
(2) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following: 
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‘‘SEC. 726. STANDARDS RELATING TO BENEFITS FOR FER-
TILITY TREATMENT. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group health insurance coverage 
shall provide coverage for fertility treatment, if such plan 
or coverage provides coverage for obstetrical services. 
‘‘(b) DEFINITION.—In this section, the term ‘fertility 
treatment’ includes the following: 
‘‘(1) Preservation of human oocytes, sperm, or 
embryos. 
‘‘(2) 
Artificial 
insemination, 
including 
intravaginal insemination, intracervical insemination, 
and intrauterine insemination. 
‘‘(3) Assisted reproductive technology, including 
in vitro fertilization and other treatments or proce-
dures in which reproductive genetic material, such as 
oocytes, sperm, and embryos, are handled, when 
clinically appropriate. 
‘‘(4) Genetic testing of embryos. 
‘‘(5) Medications prescribed or obtained over- 
the-counter, as indicated for fertility. 
‘‘(6) Gamete donation. 
‘‘(7) Such other information, referrals, treat-
ments, procedures, medications, laboratory testing, 
technologies, and services relating to fertility as the 
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Secretary of Health and Human Services determines 
appropriate. 
‘‘(c) REQUIRED COVERAGE.—A group health plan 
and a health insurance issuer offering group health insur-
ance coverage that includes coverage for obstetrical serv-
ices shall provide coverage for fertility treatment deter-
mined appropriate by the health care provider, regardless 
of whether the participant or beneficiary receiving such 
treatment has been diagnosed with infertility as defined 
by the American Society for Reproductive Medicine, if the 
treatment is performed at, or prescribed by, a medical fa-
cility that is in compliance with relevant standards set by 
an appropriate Federal agency. 
‘‘(d) 
LIMITATION.—Cost-sharing, 
including 
deductibles and coinsurance, or other limitations for fer-
tility treatment may not be imposed with respect to the 
services required to be covered under subsection (c) to the 
extent that such cost-sharing exceeds the cost-sharing ap-
plied to other medical services under the group health plan 
or health insurance coverage or such other limitations are 
different from limitations imposed with respect to such 
medical services, except where such limitation is more fa-
vorable with respect to fertility treatment. The Secretary 
shall promulgate interim final regulations to carry out this 
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subsection, notwithstanding the notice and comment re-
quirements of section 553 of title 5, United States Code. 
‘‘(e) PROHIBITIONS.—A group health plan and a 
health insurance issuer offering group health insurance 
coverage may not— 
‘‘(1) provide incentives (monetary or otherwise) 
to a participant or beneficiary to encourage such 
participant or beneficiary not to seek or obtain fer-
tility treatment to which such participant or bene-
ficiary is entitled under this section or to providers 
to induce such providers not to provide medically ap-
propriate fertility treatments to participants or bene-
ficiaries; 
‘‘(2) prohibit a provider from discussing with a 
participant or beneficiary fertility treatment relating 
to this section; 
‘‘(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided fertility treatment to a qualified participant 
or beneficiary in accordance with this section; or 
‘‘(4) on the ground prohibited under title VI of 
the Civil Rights Act of 1964 (42 U.S.C. 2000d et 
seq.), title IX of the Education Amendments of 1972 
(20 U.S.C. 1681 et seq.), the Age Discrimination 
Act of 1975 (42 U.S.C. 6101 et seq.), section 504 
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of the Rehabilitation Act of 1973 (29 U.S.C. 794), 
or section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116), exclude any 
individual from coverage in accordance with this sec-
tion, or discriminate against any individual with re-
spect to such coverage. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require a participant or bene-
ficiary to undergo fertility treatment. 
‘‘(g) NOTICE.—A group health plan and a health in-
surance issuer offering group health insurance coverage 
shall provide notice to each participant and beneficiary 
under such plan or coverage 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— 
‘‘(1) not later than the earlier of— 
‘‘(A) in the first standard mailing made by 
the plan or issuer to the participant or bene-
ficiary following the effective date of such regu-
lations; 
‘‘(B) as part of any yearly informational 
packet sent to the participant or beneficiary; or 
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