2023 Utah Code › Title 49 - Utah State Retirement and Insurance Benefit Act › Chapter 20 - Public Employees' Benefit and Insurance Program Act › Part 4 - Insurance Program › Section 418 - Expanded infertility treatment coverage pilot program.

Affected by 63I-1-249 on 1/1/2025
Effective 5/5/2021
49-20-418.
Expanded infertility treatment coverage pilot program.
(1) As used in this section:
(a) "Assisted reproductive technology" means the same as the term is defined in 42 U.S.C. Sec. 263a-7.
(b) "Physician" means the same as the term is defined in Section 58-67-102.
(c) "Pilot program" means the expanded infertility treatment coverage pilot program described in Subsection (2).
(d) "Qualified assisted reproductive technology cycle" means the use of assisted reproductive technology to transfer a single embryo for implantation.
(e) "Qualified individual" means a covered individual who is eligible for maternity benefits under the program.
(2)
(a) Beginning plan year 2018-19, and ending plan year 2023-24, the program shall offer a pilot program within the state risk pool that provides coverage to a qualified individual for the use of an assisted reproductive technology.
(b)
(i) For plan year 2018-19, 2019-20, or 2020-21, the pilot program shall offer a one-time benefit of $4,000 toward the costs of using an assisted reproductive technology for each qualified individual.
(ii) For plan year 2021-22, 2022-23, or 2023-24, the pilot program shall offer a benefit of $4,000 to a qualified individual toward the costs of each qualified assisted reproductive technology cycle.
(c) The benefits described in Subsection (2)(b) are subject to the same cost sharing requirements as the covered individual's plan.
(3) Coverage offered under the pilot program applies if:
(a) the patient who will use the assisted reproductive technology is a qualified individual;
(b)
(i) the patient's physician verifies that the patient or the patient's spouse has a demonstrated condition recognized by a physician as a cause of infertility; or
(ii) the patient attests that the patient is unable to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations without contraception;
(c) the patient attests that the patient has been unable to attain a successful pregnancy through any less-costly, potentially effective infertility treatments for which coverage is available under the health benefit plan; and
(d) the use of the assisted reproductive technology procedure is performed at a medical facility that conforms to the minimal standards for programs of assisted reproductive technology procedures adopted by the American Society for Reproductive Medicine.
(4) Coverage offered under the pilot program:
(a) shall satisfy, in accordance with Subsection 31A-22-610.1(1)(c)(ii), the requirement to provide an adoption indemnity benefit to a qualified individual under Section 31A-22-610.1;
(b) does not apply to a qualified individual if the qualified individual has received the adoption indemnity benefit required under Section 31A-22-610.1; and
(c) for plan year 2021-22, 2022-23, or 2023-24, shall apply to a qualified individual, even if the qualified individual received the benefit described in Subsection (2)(b)(i).
(5)
(a) The purpose of the pilot program is to study the efficacy of providing coverage for the use of an assisted reproductive technology and is not a mandate for coverage of an assisted reproductive technology within all health plans offered by the program.
(b) The program shall report to the Retirement and Independent Entities Interim Committee regarding the costs and benefits of the pilot program:
(i) on or before October 1; and
(ii) during calendar years 2022 and 2023.
(6) Under Section 63J-1-603, the Legislature intends that the cost of the pilot program will be paid from money above the minimum recommended level in the public employees' state risk pool reserve.
Amended by Chapter 64, 2021 General Session
Amended by Chapter 195, 2021 General Session