Title: Access to Infertility Treatment and Care Act
Policy area: Health

Summary:
Access to Infertility Treatment and Care Act
This bill amends the Public Health Service Act to require private health insurance plans that cover obstetrical services to also cover infertility treatments (e.g., in vitro fertilization). The bill also extends coverage to federal employees, members of the U.S. military, and veterans.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5965 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5965

 To require health insurance coverage for the treatment of infertility.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 24, 2018

 Ms. DeLauro introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Oversight and Government 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 committee concerned

_______________________________________________________________________

                                 A BILL


 
 To require health insurance coverage for the treatment of infertility.

    Be it enacted by the Senate and House of Representatives 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:
            (1) Infertility is a medical disease recognized by the 
        World Health Organization, the American Society for 
        Reproductive Medicine, and the American Medical Association 
        that affects men and women equally.
            (2) According to the Centers for Disease Control and 
        Prevention, 1 in 8 couples have difficulty getting pregnant or 
        sustaining a pregnancy.
            (3) Infertility affects a broad spectrum of prospective 
        parents. No matter what race, religion, sexuality, or economic 
        status one is, infertility does not discriminate.
            (4) Approximately one-third of infertility is attributed to 
        the female partner, one-third is attributed to the male 
        partner, and one-third is caused by a combination of problems 
        in both partners or is unexplained.
            (5) Infertility disproportionately affects individuals 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 reproductive system and organs, fertility preservation 
        becomes necessary.
            (6) Leading causes of infertility include chronic 
        conditions and diseases of the endocrine or metabolic systems, 
        such as primary ovarian insufficiency, polycystic ovarian 
        syndrome, endometriosis, thyroid disorders, menstrual cycle 
        defects, autoimmune disorders, hormonal imbalances, testicular 
        disorders, and urological health issues. Other causes include 
        structural problems or blockages within the reproductive 
        system, exposure to infectious diseases, occupational or 
        environmental hazards, or genetic influences.
            (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-sponsored health 
        plans found that 44 percent of employers with at least 500 
        employees did not cover infertility services, and 25 percent of 
        companies with 20,000 or more employees did not cover 
        infertility services.
            (10) States that do not require insurance coverage of 
        assisted reproductive technology have higher rates of multiple 
        births.
            (11) 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 TREATMENT OF INFERTILITY AND 
              IATROGENIC INFERTILITY.

    (a) In General.--Part A of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg et seq.) is amended by inserting after section 
2728 the following:

``SEC. 2729. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF 
              INFERTILITY AND IATROGENIC INFERTILITY.

    ``(a) In General.--A group health plan or a health insurance issuer 
offering group or individual health insurance coverage shall ensure 
that such plan or coverage provides coverage for--
            ``(1) the treatment of infertility, including 
        nonexperimental assisted reproductive technology procedures, if 
        such plan or coverage provides coverage for obstetrical 
        services; and
            ``(2) the treatment of 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 pregnancy, including in vitro fertilization, egg 
        or embryo cryopreservation, egg or embryo donation, and 
        gestational surrogacy;
            ``(2) the term `infertility' means a disease, defined by 
        the failure to achieve a successful pregnancy after 12 months 
        or more, or for women over age 35, 6 months or more, of 
        appropriate, timed unprotected intercourse or therapeutic donor 
        insemination; 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 insurance issuer offering 
        group or individual health insurance coverage that includes 
        coverage for obstetrical services shall provide coverage for 
        treatment of infertility determined appropriate by the treating 
        physician, including, as appropriate, ovulation induction, egg 
        retrieval, sperm retrieval, artificial insemination, in vitro 
        fertilization, genetic screening, intracytoplasmic sperm 
        injection, and any other non-experimental treatment, as 
        determined by the Secretary in consultation with appropriate 
        professional and patient organizations such as the American 
        Society for Reproductive Medicine, RESOLVE: The National 
        Infertility Association, and the American College of 
        Obstetricians and Gynecologists.
            ``(2) Coverage for iatrogenic infertility.--A group health 
        plan and a health insurance issuer offering group or individual 
        health insurance coverage shall provide coverage for treatment 
        of fertility preservation services for individuals who undergo 
        medically necessary treatment that may cause iatrogenic 
        infertility, as determined by the treating physician, including 
        cryopreservation of gametes and other procedures, as determined 
        by the Secretary, consistent with established medical practices 
        and professional guidelines published by professional medical 
        organizations, including the American Society for 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 individual health insurance coverage shall 
        provide coverage for assisted reproductive technology as 
        required under paragraph (1) if--
                    ``(A) the individual has been unable to bring a 
                pregnancy to a live birth through less costly 
                infertility treatments, as determined appropriate by 
                the treating physician, with consideration given to 
                participant's or beneficiary's specific diagnoses or 
                condition for which coverage is available under the 
                plan or coverage; and
                    ``(B) the treatment is performed at a medical 
                facility that--
                            ``(i) conforms to the standards of the 
                        American Society for Reproductive Medicine and 
                        the Society for Assisted Reproductive 
                        Technology; and
                            ``(ii) is in compliance with any standards 
                        set by an appropriate Federal agency.
    ``(d) Limitation.--Cost-sharing, including deductibles and 
coinsurance, or other limitations for infertility and iatrogenic 
infertility therapy 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 applied to similar services under 
the group health plan or health insurance coverage or such other 
limitations are different from limitations imposed with respect to such 
similar services.
    ``(e) Prohibitions.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not--
            ``(1) provide incentives (monetary or otherwise) to a 
        participant or beneficiary to encourage such participant or 
        beneficiary not to be provided infertility or iatrogenic 
        infertility treatments to which such participant or beneficiary 
        is entitled 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 or iatrogenic 
        infertility treatment techniques or medical treatment options 
        relating to this section; or
            ``(3) penalize or otherwise reduce or limit the 
        reimbursement of a provider because such provider provided 
        infertility or iatrogenic infertility treatments to a qualified 
        participant or beneficiary in accordance with this section.
    ``(f) Rule of Construction.--Nothing in this section shall be 
construed to require a participant or beneficiary to undergo 
infertility or iatrogenic infertility therapy.
    ``(g) Notice.--A group health plan and a health insurance issuer 
offering group or individual health insurance coverage shall provide 
notice to each participant and beneficiary under such plan regarding 
the coverage required by this section in accordance with regulations 
promulgated by the Secretary. Such notice shall be in writing and 
prominently positioned in any literature or correspondence made 
available or distributed by the plan or issuer and shall be 
transmitted--
            ``(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, 2020,
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 
negotiating 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 ``sections 2704 and 2708''.
    (c) Effective Dates.--
            (1) In general.--The amendments made by subsections (a) and 
        (b) shall apply for plan years beginning 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 1 or more collective bargaining 
                agreements between employee representatives and 1 or 
                more employers 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 collective 
                        bargaining agreements relating to the plan 
                        terminates (determined without regard 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 solely to conform to any requirement added by 
                subsection (a) shall not be treated as a termination of 
                such collective bargaining agreement.

SEC. 4. FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.

    (a) In General.--Section 8902 of title 5, United States Code, is 
amended by adding at the end the following:
    ``(p) Coverage for Diagnosis and Treatment of Infertility and 
Iatrogenic Infertility.--
            ``(1) Definitions.--In this subsection, the terms 
        `infertility' and `iatrogenic infertility' have the meanings 
        given those terms in section 2729 of the Public Health Service 
        Act.
            ``(2) Required coverage.--A contract under this chapter 
        shall provide, in a manner consistent with section 2729 of the 
        Public Health Service Act--
                    ``(A) coverage for the diagnosis and treatment of 
                infertility, including nonexperimental assisted 
                reproductive technology procedures, if such contract 
                covers obstetrical benefits; and
                    ``(B) coverage for the diagnosis and treatment of 
                iatrogenic infertility.
            ``(3) Cost.--Coverage for the diagnosis or treatment of 
        infertility or iatrogenic infertility under a health benefits 
        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 obstetrical benefits 
        under the plan.
            ``(4) Preemption.--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 2729 of the Public Health Service 
        Act.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to 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 any health benefits plan offered 
under such a contract.

SEC. 5. BENEFITS FOR TREATMENT OF INFERTILITY AND 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 following new section:
``Sec. 1110c. Obstetrical and infertility benefits
    ``(a) In General.--Any health care plan under this chapter shall 
provide, in a manner consistent with section 2729 of the Public Health 
Service Act--
            ``(1) coverage for the diagnosis and treatment of 
        infertility, including nonexperimental assisted reproductive 
        technology procedures, if such plan covers obstetrical 
        benefits; and
            ``(2) coverage for the diagnosis and treatment of 
        iatrogenic infertility.
    ``(b) Copayment.--The Secretary of Defense shall establish cost-
sharing requirements for the coverage of diagnosis and treatment of 
infertility and iatrogenic infertility described in subsection (a) that 
are consistent with the cost-sharing requirements applicable to health 
plans and health insurance coverage under section 2729(d) of the Public 
Health Service Act.
    ``(c) Regulations.--The Secretary of Defense shall prescribe any 
regulations necessary to carry out this section.
    ``(d) Definitions.--In this section, the terms `infertility' and 
`iatrogenic infertility' have the meanings given those terms in section 
2729 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 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:
``Sec. 1720J. Infertility treatment and counseling for veterans and 
              spouses or partners of veterans
    ``(a) In General.--The Secretary shall furnish treatment for 
infertility and iatrogenic infertility, including through the use of 
assisted reproductive technology, 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 and counseling through 
a process prescribed by the Secretary for purposes of this section.
    ``(b) Infertility Defined.--In this section, the terms 
`infertility' and `iatrogenic infertility' have the meanings given 
those terms in section 2729 of the Public Health Service Act.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1720I the following new item:

``1720J. Infertility treatment and counseling for veterans and spouses 
                            or partners of veterans.''.
    (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 1720J of title 38, United 
States Code, as added by subsection (a).
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