I
106TH CONGRESS
2D SESSION
H. R. 4532
To assure equitable treatment of fertility and impotence in health care cov-
erage under group health plans, health insurance coverage, and health
plans under the Federal employees’ health benefits program.
IN THE HOUSE OF REPRESENTATIVES
MAY 24, 2000
Mr. ANDREWS introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Education
and the Workforce, and Government Reform, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To assure equitable treatment of fertility and impotence in
health care coverage under group health plans, health
insurance coverage, and health plans under the Federal
employees’ health benefits program.
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 ‘‘Equity in Fertility
Coverage Act of 2000’’.
SEC. 2. EQUITY IN PROVISION OF PRESCRIPTION DRUG
COVERAGE.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act is amended by adding
at the end the following new section:
‘‘SEC. 2707. EQUITY IN FERTILITY COVERAGE.
‘‘(a) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insurance
coverage, that provides for coverage of impotency medica-
tions such as viagra shall also provide coverage of fertility
treatments.
‘‘(b) CONSTRUCTION.—Nothing in this section shall
be construed as preventing a plan or issuer from—
‘‘(1) restricting the drugs for which benefits are
provided under the plan or health insurance cov-
erage, or
‘‘(2) imposing a limitation on the amount of
benefits provided with respect to such coverage or
the cost-sharing that may be imposed with respect to
such coverage,
so long as such restrictions and limitations are consistent
with subsection (a).
‘‘(c) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(c) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2707’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 (as added by
section 603(a) of the Newborns’ and Mothers’
Health Protection Act of 1996 and amended by sec-
tion 702(a) of the Mental Health Parity Act of
1996) is amended by adding at the end the following
new section:
‘‘SEC. 714. EQUITY IN FERTILITY COVERAGE.
‘‘(a) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insurance
coverage, that provides for coverage of impotency medica-
tions such as viagra shall also provide coverage of fertility
treatments.
‘‘(b) CONSTRUCTION.—Nothing in this section shall
be construed as preventing a plan or issuer from—
‘‘(1) restricting the drugs for which benefits are
provided under the plan or health insurance cov-
erage, or
‘‘(2) imposing a limitation on the amount of
benefits provided with respect to such coverage or
the cost-sharing that may be imposed with respect to
such coverage,
so long as such restrictions and limitations are consistent
with subsection (a).
‘‘(c) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Equity in fertility coverage.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2751 the following new sec-
tion:
‘‘SEC. 2752. EQUITY IN FERTILITY COVERAGE.
‘‘(a) IN GENERAL.—The provisions of section 2707
(other than subsection (c)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 714(c) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(c) FEHBP.—Section 8902 of title 5, United States
Code, is amended by adding at the end the following the
following new subsection:
‘‘(o) A contract may not be made or a plan approved
which excludes does not comply with the requirements of
section 2752 of the Public Health Service Act.’’.
(d) EFFECTIVE DATES.—(1) The amendments made
by subsection (a) shall apply with respect to group health
plans for plan years beginning on or after January 1,
2001.
(2) The amendments made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after January 1, 2001.
(3) The amendment made by subsection (c) shall
apply with respect to contracts for periods beginning on
and after January 1, 2001.
(e) COORDINATED REGULATIONS.—Section 104(1) of
Health Insurance Portability and Accountability Act of
1996 is amended by striking ‘‘this subtitle (and the
amendments made by this subtitle and section 401)’’ and
inserting ‘‘the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of
1974, and the provisions of parts A and C of title XXVII
of the Public Health Service Act’’.
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