An Act To Provide Access to Fertility Care
Maine Legislature, Session 130, LD 1539
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MADIGAN, DAUGHTRY, CRAVEN, EVANS, FECTEAU, MEYER, BRENNER, CARNEY
Amends: 24-A MRSA §4320-Q

Legislative Document
No. 1539
H.P. 1144
House of Representatives, April 22, 2021
An Act To Provide Access to Fertility Care
Received by the Clerk of the House on April 20, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed pursuant to Joint Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative MADIGAN of Waterville.
Cosponsored by Senator DAUGHTRY of Cumberland and
Representatives: CRAVEN of Lewiston, EVANS of Dover-Foxcroft, Speaker FECTEAU of 
Biddeford, MEYER of Eliot, Senators: BRENNER of Cumberland, CARNEY of Cumberland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4320-Q is enacted to read:
§4320-Q.  Coverage for fertility services
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Experimental fertility procedure" means a procedure for which the published 
medical evidence is not sufficient for the American Society for Reproductive Medicine, 
its successor organization or a comparable organization to regard the procedure as 
established medical practice.
B. "Fertility diagnostic care" means procedures, products, medications and services 
intended to provide information about an individual's fertility, including laboratory 
assessments and imaging studies.
C. "Fertility patient" means an individual or couple with infertility or an individual 
unable to conceive as an individual or with a partner because the individual or couple 
does not have the necessary gametes for conception.
D.  "Fertility preservation services" means procedures, products, medications and 
services, intended to preserve fertility, consistent with established medical practice and 
professional guidelines published by the American Society for Reproductive Medicine, 
its successor organization or a comparable organization for an individual who has a 
medical or genetic condition or who is expected to undergo treatment that may directly 
or indirectly cause a risk of impairment of fertility.  "Fertility preservation services" 
includes the procurement and cryopreservation of gametes, embryos and reproductive 
material and storage from the time of cryopreservation for a period of 5 years.  Storage 
may be offered for a longer period of time.
E. "Fertility treatment" means procedures, products, medications and services intended 
to achieve pregnancy consistent with established medical practice and professional 
guidelines published by the American Society for Reproductive Medicine, its successor 
organization or a comparable organization. 
F. "Gamete" means a cell containing a haploid complement of deoxyribonucleic acid 
that has the potential to form an embryo when combined with another gamete.  
"Gamete" includes sperm and eggs.
G. "Infertility" means the presence of a demonstrated condition recognized by a 
provider as a cause of loss or impairment of fertility or a couple's inability to achieve 
pregnancy after 12 months of unprotected intercourse when the couple has the 
necessary gametes for conception, including the loss of a pregnancy occurring within 
that 12-month period, or after a period of less than 12 months due to a person's age or 
other factors.  Pregnancy resulting in a loss does not cause the time period of trying to 
achieve a pregnancy to be restarted.
2.  Required coverage.  A carrier offering a health plan in this State shall provide 
coverage as provided in this subsection to an enrollee: 
A.  For fertility diagnostic care; 
B.  For fertility treatment if the enrollee is a fertility patient; and 
C.  For fertility preservation services.
Coverage under this subsection must include evaluations, laboratory assessments, 
medications and procedures intended to achieve pregnancy, including but not limited to the 
procurement of donor gametes.  Coverage must be provided to the same extent that 
coverage is provided for other medical services or prescription drugs.  Coverage under this 
subsection may not be denied to any enrollee who foregoes a particular fertility treatment 
or fertility preservation service if a provider determines that such fertility treatment or 
fertility preservation service is likely to be unsuccessful.
3.  Limitations on coverage.  A health plan that provides coverage for the services 
required by this section may include reasonable limitations to the extent that these 
provisions are not inconsistent with the following requirements.
A. A carrier may not impose deductibles, copayments, coinsurance, maximum benefits, 
waiting periods or other limitations that are different from those that are imposed on 
coverage for other services under the health plan or any limitations on coverage for 
prescribed fertility medication that are different from those that are imposed on other 
prescription medication. 
B. A carrier may not use any prior diagnosis or prior fertility treatment as a basis for 
excluding, limiting or otherwise restricting the availability of coverage required by this 
section. 
C. A carrier may not impose any limitations on coverage for any fertility services based 
on an enrollee's use of donor gametes, donor embryos or surrogacy.
D. A carrier may not impose any limitations on coverage solely based on arbitrary 
factors, such as number of conception attempts, dollar amounts or age of an enrollee, 
or provide different benefits to or impose different requirements on a class of persons 
protected under Title 5, chapter 337 than those limitations placed on other enrollees. 
E. Any limitations imposed by a carrier must be based on an enrollee's medical history 
and clinical guidelines.  Any clinical guidelines used by a carrier must be maintained 
in written form and must be made available to an enrollee in writing upon request.  
Clinical guidelines developed by the American Society for Reproductive Medicine, its 
successor organization or a comparable organization may serve as a basis for a carrier's 
clinical guidelines.  Making, issuing, circulating or causing to be made, issued or 
circulated any clinical guidelines that are based on data that are not reasonably current 
or that do not cite with any specificity any reference relied upon constitutes an unfair 
or deceptive act or practice in the business of insurance pursuant to section 2152.
4.  Certain services not required.  This section does not require a carrier to provide 
coverage for: 
A. Any experimental fertility procedure; or 
B. Any nonmedical costs related to donor gametes, donor embryos or surrogacy. 
5.  Rules.  The superintendent shall adopt rules as necessary to implement the 
requirements of this section. Rules adopted pursuant to this subsection are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 2.  Application.  This Act applies to all policies, contracts and certificates 
executed, delivered, issued for delivery, continued or renewed in this State on or after 
January 1, 2023. 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 carriers offering health plans in this State to provide coverage for 
fertility diagnostic care, for fertility treatment if the enrollee is a fertility patient and for 
fertility preservation services.  The requirements of the bill apply to health plans issued or 
renewed on or after January 1, 2023.