House File 178 - Introduced HOUSE FILE BY D. OLSON Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act relating to third=party payment of health care coverage 2 costs for the diagnosis and treatment of infertility and 3 providing an applicability date. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1011HH 82 6 av/je/5 PAG LIN 1 1 Section 1. NEW SECTION. 514C.23 INFERTILITY COVERAGE. 1 2 1. Notwithstanding the uniformity of treatment 1 3 requirements of section 514C.6, a group policy, contract, or 1 4 plan providing for third=party payment or prepayment of 1 5 health, medical, and surgical coverage benefits issued by a 1 6 carrier, as defined in section 513B.2, or by an organized 1 7 delivery system authorized under 1993 Iowa Acts, ch. 158, 1 8 shall provide coverage benefits for the diagnosis and 1 9 treatment of infertility, if both of the following are 1 10 satisfied: 1 11 a. The policy, contract, or plan is issued to an employer 1 12 who on at least fifty percent of the employer's working days 1 13 during the preceding calendar year employed more than twenty= 1 14 five full=time equivalent employees. In determining the 1 15 number of full=time equivalent employees of an employer, 1 16 employers who are affiliated or who are able to file a 1 17 consolidated tax return for purposes of state taxation shall 1 18 be considered one employer. 1 19 b. The policy, contract, or plan provides coverage 1 20 benefits related to pregnancy. 1 21 2. Notwithstanding the uniformity of treatment 1 22 requirements of section 514C.6, a plan established pursuant to 1 23 chapter 509A for public employees shall provide coverage 1 24 benefits for the diagnosis and treatment of infertility. 1 25 3. For purposes of this section, "infertility" means the 1 26 inability to conceive after one year of unprotected sexual 1 27 intercourse or the inability to sustain a successful 1 28 pregnancy. 1 29 4. For purposes of this section, the diagnosis and 1 30 treatment of infertility includes but is not limited to all of 1 31 the following: 1 32 a. In vitro fertilization. 1 33 b. Uterine embryo lavage. 1 34 c. Embryo transfer. 1 35 d. Artificial insemination. 2 1 e. Gamete intrafallopian tube transfer. 2 2 f. Zygote intrafallopian tube transfer. 2 3 g. Low tubal ovum transfer. 2 4 5. Coverage benefits required under this section for in 2 5 vitro fertilization, gamete intrafallopian tube transfer, or 2 6 zygote intrafallopian tube transfer shall be required only if 2 7 all of the following conditions are satisfied: 2 8 a. The covered individual has been unable to attain or 2 9 sustain a successful pregnancy through reasonable, less 2 10 costly, medically=appropriate infertility treatments for which 2 11 coverage is available under the policy, contract, or plan. 2 12 b. The covered individual has not undergone more than 2 13 three completed oocyte retrievals, except that if a live birth 2 14 follows a completed oocyte retrieval, then two more completed 2 15 oocyte retrievals shall be covered. 2 16 c. The procedures are performed at a medical facility that 2 17 conforms to the American college of obstetrics and gynecology 2 18 guidelines for in vitro fertilization clinics or to the 2 19 American society for reproductive medicine's minimum standards 2 20 for in vitro fertilization programs. 2 21 6. This section does not apply to a group policy, 2 22 contract, or plan issued to or by a religious institution or 2 23 organization or to or by an entity sponsored by a religious 2 24 institution or organization if the religious and moral 2 25 teachings or beliefs of the religious institution or 2 26 organization would be violated by providing the coverage 2 27 benefits otherwise required under this section. 2 28 7. This section shall not apply to accident=only, 2 29 specified disease, short=term hospital or medical, hospital 2 30 confinement indemnity, credit, dental, vision, Medicare 2 31 supplement, long=term care, basic hospital and medical= 2 32 surgical expense coverage as defined by the commissioner, 2 33 disability income insurance coverage, coverage issued as a 2 34 supplement to liability insurance, workers' compensation or 2 35 similar insurance, or automobile medical payment insurance, or 3 1 individual accident and sickness policies issued to 3 2 individuals or to individual members of a member association. 3 3 8. This section applies to third=party payment provider 3 4 policies or contracts and to plans established pursuant to 3 5 chapter 509A that are delivered, issued for delivery, 3 6 continued, or renewed in this state on or after January 1, 3 7 2008. 3 8 EXPLANATION 3 9 This bill mandates payment of health care costs for the 3 10 diagnosis and treatment of infertility in certain health 3 11 insurance policies, contracts, or plans issued to employers of 3 12 more than 25 full=time employees who provide coverage benefits 3 13 related to pregnancy, and in plans established pursuant to 3 14 Code chapter 509A for public employees. 3 15 The bill defines "infertility" as the inability to conceive 3 16 after one year of unprotected sexual intercourse or the 3 17 inability to sustain a successful pregnancy. 3 18 The bill provides that coverage for the diagnosis and 3 19 treatment of infertility includes but is not limited to in 3 20 vitro fertilization, uterine embryo transfer, artificial 3 21 insemination, gamete intrafallopian tube transfer, zygote 3 22 intrafallopian tube transfer, and low tubal ovum transfer. 3 23 The bill limits the requirement for coverage for in vitro 3 24 fertilization, gamete intrafallopian tube transfer, or a 3 25 zygote intrafallopian tube transfer to those cases where the 3 26 covered individual has been unable to attain or sustain a 3 27 successful pregnancy through reasonable, less costly, 3 28 medically=appropriate infertility treatments for which 3 29 coverage is available under the policy, contract, or plan, and 3 30 the individual has not undergone more than three complete 3 31 oocyte retrievals, except that if a live birth follows a 3 32 completed oocyte retrieval, two more completed oocyte 3 33 retrievals are covered, and the procedures are performed at a 3 34 medical facility that meets guidelines of the American college 3 35 of obstetrics and gynecology or minimum standards of the 4 1 American society for reproductive medicine for in vitro 4 2 fertilization programs. 4 3 Infertility coverage is not required in a group policy, 4 4 contract, or plan issued to or by a religious institution or 4 5 organization or an entity sponsored by such an institution or 4 6 organization if the religious and moral teachings or beliefs 4 7 of the religious institution or organization would be violated 4 8 by such a requirement. 4 9 The bill does not apply to certain specified types of 4 10 insurance policies. 4 11 The bill applies to third=party payment provider policies 4 12 or contracts and to plans established pursuant to Code chapter 4 13 509A that are delivered, issued for delivery, continued, or 4 14 renewed in this state on or after January 1, 2008. 4 15 LSB 1011HH 82 4 16 av:rj/je/5