An Act To Assist Maine's Infertile Citizens LR 0751(02)
Maine Legislature, Session 121, LD 0213
Committee Amendment CA_A_H629 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2847, 24-A MRSA §4252

COMMITTEE AMENDMENT .. 4 
.. to H. P . 
, 
Act To Assist Maine's Infertile Citizens" 
L.D. 213, Bill, "An 
Amend the bill by striking out everything after the enacting 
clause and before the summary and inserting in its place the 
following: 
'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 ~ 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, 
contracts 
and 
certificates 
that 
provide 
coverage 
for 
pregnancy-related 
benefits 
must 
provide 
coverage 
for 
the 
diagnosis 
and 
treatment 
of 
infertility, 
including, 
but 
not 
limi ted to, in vitro fertilization, embryo transfer, artificial 
insemination, 
gamete 
intrafallopian 
tube 
transfer, 
~ote 
intrafallopian tube transfer and 
low tubal ovum transfer, 
Ul 
accordance with this section. 
Page l-LR0751(2) 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. ff.. to H. P • 172, L . D . 213 
3. 
Conditions. 
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. The covered person must have a referral for infertili ty 
diagnosis 
and 
treatment 
by 
that person's 
primary 
care 
provider; 
c. 
The policy, contract or certificate may not impose a 
coinsurance requirement for coverage under this section that 
exceeds 20°-0: 
D. 
The 
policy, 
contract or 
certificate must 
impose 
a 
lifetime maximum limit of $20,000 for the coverage required 
under this section; 
E. 
For 
a policy, 
contract or certificate that provides 
prescription 
drug 
coyerage, 
the 
policy, 
contract 
or 
certificate 
may 
not 
impose 
special 
restrictions 
on 
prescription medications or a restriction or limitation on 
the number of procedures used for infertility diagnosis or 
treatment: 
F. 
The policy, contract or certificate 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: and 
G. 
The policy, contract or certificate 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 emplo,yer. 
A religious employer 
may request and an insurer shall grant an exclusion under the 
POlicy, contract or certificate 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 
insureds 
and 
those 
individualS insured under its policy, contract or certificate 
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 
treatment 
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 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. fI.. to H. P. 172, L. D. 213 
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 
SOl(e} (3), 
5. 
Limits; coinsurance; deductibles. 
Any policy, contract 
or certificate that provides coverage for services under this 
section 
may 
contain 
provisions 
for 
maximum 
benefits 
and 
coinsurance 
and 
reasonable 
limitations, 
deductibles 
and 
exclusions 
to 
the 
extent 
that 
these 
provisions 
are 
not 
inconsistent with the requirements of this section. 
6. 
Re.port to superintendent. 
An insurer subject to this 
section shall report its experience for the calendar years 2005, 
2006 and 2007 to the superintendent not later than February 15, 
2008. 
The 
report 
must 
be 
in 
a 
form 
prescribed 
by 
the 
superintendent and include the 
amount of claims paid by the 
insurer in this State for the infertility treatment services 
required by this section, the total amount of claims paid by the 
insurer in this State for group health care contracts and the 
effect of coyer age required under this section on the cost of the 
insurer I s group health insurance premiums. 
The superintendent 
shall compile this data for all group insurers and submit a 
report to the joint standing committee of the Legislature having 
jurisdiction oyer health insurance matters on or before April 1, 
2..Q.Q1L.. 
Sec.3. 24-A MRSA §4252 is enacted to read: 
§4252. 
Infertilit~ 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 
and 
certificates 
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, 
in 
accordance with this section. 
3. 
Conditions. 
The coverage required by this section IS 
subject to the following conditions: 
COMMITTEE AMENDMENT 
,'" 
.,.'~, 
COMMITTEE AMENDMENT "/{" to H. P. 172, L. D. 213 
A. 
The female partner must be 21 years of age or older and 
under 45 years of age; 
B. The covered person must have a referral for infertility 
diagnosis 
and 
treatment 
by 
that 
person's 
primary 
care 
provider; 
C. 
The contract or certificate may not impose a coinsurance 
requirement for coverage under this section that exceeds 20%; 
D. 
The contract or certificate must 
impose 
a 
lifetime 
maximum limit of $20, QOO 
for the coverage required under 
this section; 
E. 
For a contract or certificate that provides prescription 
drug coverage, the contract or certificate may not impose 
special 
restrictions 
on 
prescription 
medications 
or 
a 
restriction or limitation on the number of procedures used 
for infertility diagnosis or treatment; 
F. The contract or certificate may re<;[uire 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; and 
G. 
The contract or certificate 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 emplqyer. 
A religious employer 
may re<;[uest and a health maintenance organization shall grant an 
exclusion under the contract or ·certificate 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 
covered 
individuals 
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 treatment 
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, 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,,~t to H.P. 172, L.D. 213 
Section 
3121(w) 
(3) 
(A) 
and that gua1ifies 
as 
a 
tax-exempt 
organization under 26 United States Code, Section 501Cc) (3). 
5. 
Limits; 
coinsurance: 
deductibles. 
Any 
contract 
or 
certificate that provides 
coverage 
for 
services 
under 
this 
section 
may 
contain 
provl.sl.ons 
for 
maximum 
benefits 
and 
coinsurance 
and 
reasonable 
limitations, 
deductibles 
and 
exclusions 
to 
the 
extent 
that 
these 
provl.sl.ons 
are 
not 
inconsistent with the requirements of this section. 
6. 
Report 
to 
superintendent. 
A 
health 
maintenance 
organization subject to this section shall report its experience 
for calendar years 2005, 2006 and 2007 to the superintendent not 
later than February 15, 2008. 
The report must be in a 
form 
prescribed by the superintendent and include the amount of claims 
paid by the health maintenance organization in this State for the 
infertility treatment services 
reguired by this section, 
the 
total 
amount 
of 
claims 
paid 
by 
the 
health 
maintenance 
organization in this State for group health care contracts and 
the effect of coverage required under this section on the cost of 
the health maintenance organization's group health maintenance 
organization premiums. 
The 
superintendent shall compile this 
data for all group health maintenance organizations and submit a 
report to the joint standing committee of the Legislature having 
jurisdiction over health insurance matters on or before April 1, 
2008. 
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, 2005. 
For purposes of this Act, 
all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. 5. 
Repeal. 
Unless 
continued 
or 
modified 
by 
the 
Legislature, this Act is repealed July 1, 2008. ' 
SUMMARY 
This 
amendment replaces the bill. The 
amendment requires 
<Jroup health insurance policies, contracts and certificates to 
include coverage for infertility treatment based on the current 
benefit provided to state employees. 
Coverage is required for 
women between ages 21 and 45, if referred by a primary care 
provider, for 80°" of the charges for infertility diagnosis and 
treatment up to a maximum lifetime limit of $20,000. Under the 
amendment, 
a 
religious employer 
may 
request 
an 
exemption if 
providing the coverage conflicts with the employer's bona fide 
religious beliefs and practices. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,~, to H.P. 172. L.D. 213 
The amendment applies to all group policies, contracts and 
certificates issued or renewed on or after January 1, 2005. 
It 
requires group insurers and health maintenance organizations to 
report claims experience and cost impact of infertility coverage 
for calendar years 2005, 2006 and 2007 no later than February 15, 
2008 and directs the Superintendent of Insurance to compile this 
information in a report to the Legislature by April 1, 2008. 
The 
amendment also repeals the provision on July 1, 2008. 
FISCAL ".;OTE iUVLlRED 
tSee attached) 
... 
-.-~ 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 01/02/04 frac::.. 
Office of Fiscal and Program Review 
LD213 
An Act To Assist Maine's Infertile Citizens 
LR 0751(02) 
Fiscal Note for Bill as Amended by Committee Amendment" " 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Minority Report 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Department of Professional and Financial Regulation can be absorbed by the Department 
within existing resources. No fiscal impact on the state employee health plan is expected because the provisions of the 
bill are consistent with the current coverage for infertility benefits provided under the plan. 
LR0751(2) - Fiscal Note - Page 1 of 1