An Act To Assist Maine's Infertile Citizens
Maine Legislature, Session 121, LD 0213
Committee: Insurance and Financial Services
Sponsors: MARRACI-IE, DOUGLASS, DUDLEY, GAGNE-FRIEL, LA VERRIERE-BOUCHER, LORING, PINGREE, RICHARDSON, SMITH
Amends: 24 MRSA §2317-B, 24-A MRSA §2847-L

Legislative Document 
No. 213 
H.P.172 
House of Representati ves, January 21, 2003 
An Act To Assist Maine's Infertile Citizens 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative MARRACI-IE of Waterville. 
Cosponsored by Senator DOUGLASS of Androscoggin and 
17/~ 
/J1.7J?P£~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: DUDLEY of Portland, GAGNE-FRIEL of Buckfield, LA VERRIERE-
BOUCHER of Biddeford, LORING of the Penobscot Nation, McKEE of Wayne, PINGREE of 
North Haven, RICHARDSON of Brunswick, SMITH of Van Buren. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24 MRSA §2317-B, sub-§16-B is enacted to read: 
16-B. 
Title 24-A. sections 2847-L and 4252. 
Group coverage 
of infertility treatment, Title 24-A, sections 2847-L and 4252; 
Sec. 2. 24-A MRSA §2847-L is enacted to read: 
§2847-L. 
Infertility coverage 
1. 
Definition. 
For 
the 
purposes 
of 
this 
section, 
.. infertility" means the disease or condition that results in the 
abnormal function of the reproductive system such that a male is 
not able to impregnate a female or a female is not able to become 
pregnant and maintain a pregnancy to full term after one year of 
attempting pregnancy. 
2. 
Coverage. 
All 
group health 
insurance policies 
and 
contracts that provide coverage for pregnancy-related benefits 
must 
provide 
coverage 
for 
the 
diagnosis 
and 
treatment 
of 
infertility, 
including, 
but 
not 
limited 
to, 
in 
vitro 
fertilization, embryo transfer, artificial insemination, gamete 
intrafallopian tube transfer, zygote intrafallopian tube transfer 
and low tubal ovum transfer. 
3. 
Limits. 
The 
coverage 
reguired by 
this 
section is 
subject to the following conditions: 
, 
A. 
The female partner must be 21 years of age or older and 
under 45 years of age: 
B. 
For a policy that provides prescription drug coverage, 
the 
policy 
may 
not 
impose 
special 
restrictions 
on 
prescription medications or a restriction or limitation on 
the number of procedures used for infertility diagnosis or 
treatment, except as provided in this subsection: 
C. 
Coverage for procedures for intrauterine insemination 
with ovarian stimulation and procedures reguiring oocyte 
retrieval may be limited in accordance with the following. 
(I) 
The policy may reguire that the covered individual 
has 
been unable to attain or sustain a 
successful 
pregnancy 
through 
reasonable, 
less 
costly medically 
appropriate infertility treatments for which coverage 
is available under the policy or contract. 
(2) 
The policy may limit the covered individual to a 
maximum of 6 completed intrauterine inseminations with 
ovarian stimulation, except that if the individual has 
Page l-LR075l(1) 
• 
a living child, then the policy may limit coverage to 3 
completed 
intrauterine 
inseminations 
with 
ovarian 
stimulation. 
(3) The policy may limit the covered individual to a 
maximum of 4 completed oocyte retrievals, except that 
if the indiyidual has a liying child, then the policy 
may limit coverage to 2 completed oocyte retrievals. 
(4) 
For procedures for intrauterine inseminations and 
procedures 
reguiring 
oocyte 
retrievals 
that 
also 
involve the 
use of donor gametes or 
a 
gestational 
carrier, the policy may coyer only medical expenses and 
the number of procedures may be limited as permitted in 
this subsection. 
(5) The policy may reguire that procedures be performed 
at medical facilities that conform to the American 
Society 
for 
Reproductiye 
Medicine 
guidelines 
as 
outlined 
by 
the 
Society 
for 
Assisted 
Reproductive 
Technology or a successor organization; 
D. 
For procedures using cryopreserved embryos, all costs, 
except for storage costs, must be covered; and 
E. 
The 
policy may 
not include coverage 
for 
procedures 
defined by the American Society for ReproduCtive Medicine or 
a successor organization as experimental or investigational. 
4. 
Exclusion for religious employer. 
A religious employer 
may reguest and an insurer shall grant an exclusion under the 
policy or contract for the coyerage required by this section if 
the reguired coverage conflicts with the religious employer's 
bona fide religious beliefs and practices. 
A religious employer 
that obtains an exclusion under this subsection shall provide 
prospective insureds 
and those individuals insured under its 
policy written notice of the exclusion. This subsection may not 
be construed as authorizing an insurer to exclude coverage for 
medically 
necessary 
procedures 
or 
for 
prescription 
drugs 
prescribed for reasons other than infertility purposes. 
For the 
purposes 
of 
this 
subsection, 
"religious 
employer" 
means 
an 
employer that is a church, conyention or association of churches 
or an elementary or secondary school that is controlled, operated 
or principally supported by 
a 
church or by 
a 
convention or 
association of churches as defined in 26 United States Code, 
Section 
3121(w) 
(3) 
(A) 
and that qualifies 
as 
a 
tax-exempt 
organization under 26 United States Code, Section 501(c) (3). 
Sec.3. 24·A MRSA §4252 is enacted to read: 
§4252. 
Infertility coverage 
1. 
Definition. 
For 
the 
purposes 
of 
this 
section, 
"infertility" means the disease or condition that results in the 
abnormal function of the reproductive system such that a male is 
not able to impregnate a female or a female is not able to become 
pregnant and maintain a pregnancy to full term after one year of 
attempting pregnancy. 
2. 
Coverage. 
All 
group health maintenance organization 
contracts 
that 
provide 
for 
coverage 
for 
pregnancy-related 
benefits must provide coverage for the diagnosis and treatment of 
infertility, 
including, 
but 
not 
limited 
to, 
in 
vitro 
fertilization, 
embryo transfer, artificial insemination, gamete 
intrafallopian tube transfer, zygote intrafallopian tube transfer 
and low tubal ovum transfer. 
3. 
Limits. 
The 
coverage 
required 
by 
this 
section is 
subject to the following conditions: 
A. 
The female partner must be 21 years of age or older and 
under 45 years of age; 
B. 
For a policy that provides prescription drug coverage, 
the 
policy 
may 
not 
impose 
special 
restrictions 
on 
prescription medications or a restriction or limitation on 
the ,number of procedures used for infertility diagnosis or 
treatment, except as provided in this subsection; 
C. 
Coverage for procedures for intrauterine insemination 
with ovarian stimulation and procedures 
requ~r~ng oocyte 
retrieval may be limited in accordance with the following. 
(1) 
The policy may require that the covered individual 
has 
been 
unable 
to 
attain or 
sustain 
a 
pregnancy 
through reasonable, less costly medically appropriate 
infertility treatments for which coverage is available 
under the policy or contract. 
(2) 
The policy may limit the covered individual to a 
maximum of 6 completed intrauterine inseminations with 
ovarian stimulation, except that if the individual has 
a living child, then the policy may limit coverage to 3 
completed 
intrauterine 
inseminations 
with 
ovarian 
stimulation. 
(3) The policy may limit the covered individual to a 
maximum of 4 completed oocyte retrievals, except that 
if the individual has a living child, then the policy 
may limit coverage to 2 completed oocyte retrievals. 
• 
(4) 
For procedures for intrauterine inseminations and 
procedures 
requiring 
oocyte 
retrievals 
that 
also 
involve the 
use 
of 
donor 
gametes or 
a 
gestational 
carrier, the policy may cover only medical expenses and 
the number of procedures may be limited as permitted in 
this subsection. 
(5) The policy may require that procedures be performed 
at medical facilities that conform to 
the American 
Society 
for 
Reproductive 
Medicine 
guidelines 
as 
outlined 
by 
the 
Society 
for 
Assisted 
Reproductive 
Technology or a successor organization; 
D. 
For procedures using cryopreserved embryos, all costs, 
except for storage costs, must be covered; and 
E. 
The 
policy may 
not 
include 
coverage for procedures 
defined by the American Society for Reproductive Medicine or 
a successor organization as experimental or investigational. 
4. 
Exclusion for religious employer. 
A religious employer 
may request and a health maintenance organization shall grant an 
exclusion under the policy or contract for the coverage required 
by this section if the required coverage conflicts with the 
religious employer's bona fide religious beliefs and practices. 
A 
religious 
employer 
that 
obtains 
an 
exclusion 
under 
this 
subsection 
shall 
provide 
prospective 
enrollees 
and 
those 
individuals 
covered 
under 
its policy written notice 
of 
the 
exclusion. This subsection may not be construed as authorizing a 
health maintenance organization to exclude coverage for medically 
necessary procedures or for prescription drugs prescribed for 
reasons other than infertility purposes. 
For the purposes of 
this subsection, "religious employer" means an employer that is a 
church, convention or association of churches or an elementary or 
secondary school 
that is controlled, 
operated or principally 
supported by 
a 
church or by 
a 
convention or association of 
churches as defined in 26 United States Code, Section 3l2l(w) (3) 
(A) 
and that qualifies as 
a 
tax-exempt organization under 
United States Code, Section 50l(c) (3). 
Sec. 4. Application. 
The requirements of this Act apply to 
all 
group 
policies, 
contracts 
and 
certificates 
executed, 
delivered, 
issued for delivery, 
continued or renewed in this 
State on or after January 1, 2004. 
For purposes of this Act, 
all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
SUMMARY 
This 
bill 
requires 
group 
health 
insurance 
contracts and certificates to include coverage for 
treatment if pregancy-related benefits are provided. 
to all group policies issued or renewed on or after 
2004. 
policies, 
infertility 
It applies 
January 1,