An Act To Require Insurance Coverage for Infertility Treatments
Maine Legislature, Session 123, LD 0842
Committee: Insurance and Financial Services
Sponsors: ROBINSON, CAIN, GILES
Amends: 24 MRSA §2317-B, 24-A MRSA §2847-M, 24-A MRSA §4253

Legislative Document 
No. 842 
H.P.641 
House of Representatives, February 23, 2007 
An Act To Require Insurance Coverage for Infertility Treatments 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative ROBINSON of Raymond. 
17/~ 
1J7.11Ju~ 
MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Representatives: CAIN of Orono, GILES of Belfast. 
Prmled 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-M and 4253. 
Group coverage of infertility 
treatment, Title 24-A, sections 2847-M and 4253; 
Sec. 2. 24-A MRSA §2847-M is enacted to read: 
§2847-M. Infertility coverage 
1. Definition. For the purposes of this section, "infertility" means a 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 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 requiring 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 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 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 
I 
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 
1 
investigational. 
4. Exclusion 'for religious employer. A religious employer may request and an 
insurer 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 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, 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 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 §4253 is enacted to read: 
§4253. Infertility coverage 
1. Definition. For the purposes of this section, "infertility" means a 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 requiring 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 
3121(w) (3) (A) and that qualifies as a tax-exempt organization under 26 United States 
Code, Section 501(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, 2008. 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 policies, contracts and certificates to include 
coverage for infertility treatment if pregancy-related benefits are provided. It applies to 
all group policies issued or renewed on or after January 1,2008.