SF 130 (LSB 1312XS (4) 91)

SENATE FILE 130

BY  PETERSEN, BISIGNANO, BLAKE, WINCKLER, CELSI, DONAHUE, DOTZLER, TOWNSEND, WAHLS, BENNETT, and WEINER

A BILL FOR

An Act relating to health insurance coverage for infertility.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.37  Infertility —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “ASRM” means the American society for reproductive medicine or its successor organization.
   b.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   c.  “Diagnosis of and treatment for infertility” means the procedures and medications recommended by a health care professional that are consistent with established, published, or approved medical practices or professional guidelines from the American college of obstetricians and gynecologists or its successor organization, or ASRM, for diagnosing and treating infertility.
   d.  (1)  “Failure to impregnate or conceive” means any of the following:
   (a)  For a woman under the age of thirty-five, the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination.
   (b)  For a woman thirty-five years of age or older, the failure to establish a clinical pregnancy after six months of regular, unprotected sexual intercourse or therapeutic donor insemination.
   (2)  Conception resulting in a miscarriage does not restart the twelve-month or six-month time period required to qualify as having infertility.
   e.  “Health care professional” means the same as defined in section 514J.102.
   f.  “Infertility” means a disease or condition characterized by any of the following:
   (1)  The failure to impregnate or conceive.
   (2)  A person’s inability to reproduce either as an individual or with the person’s partner.
   (3)  A health care professional’s diagnosis based on a covered person’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.
   g.  “Standard fertility preservation services” means procedures and services consistent with established medical practices or professional guidelines published by ASRM or the American society of clinical oncology or its successor organization for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by health care professionals to cause a risk of fertility impairment.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage for a covered person for the diagnosis of and treatment for infertility, and standard fertility preservation services.
   b.  The coverage required by this subsection shall include up to three completed oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of the ASRM, using single embryo transfer if recommended and medically appropriate.
   c.  The coverage required under this subsection for fertility medications shall not be less favorable than coverage offered for any other prescription medications under the policy, contract, or plan.
   d.  Except as otherwise provided in this section, deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations on coverage for a covered person for the diagnosis of and treatment for infertility, and standard fertility preservation services, shall not be less favorable than the deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations imposed on any other benefit for services covered under the policy, contract, or plan.
   3.  A religious employer may request, and a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall grant, an exclusion from the coverage required under this section if the required coverage conflicts with the religious employer’s bona fide religious beliefs and practices. A religious employer granted an exclusion under this subsection shall provide its employees timely notice of the exclusion from the policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses the religious employer offers its employees.
   4.  a.  This section applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2025:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established for public employees pursuant to chapter 509A.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   5.  The commissioner of insurance may adopt rules pursuant to chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to health insurance coverage for the diagnosis of and treatment for infertility, and standard fertility preservation services (preservation services).
   The bill requires a policy, contract, or plan (plan) providing for third-party payment or prepayment of health or medical expenses to provide coverage for the diagnosis of and treatment for infertility, and for preservation services. “Diagnosis of and treatment for infertility”, “infertility”, and “standard fertility preservation services” are defined in the bill. Required coverage includes up to three completed oocyte retrievals with unlimited embryo transfers, using single embryo transfer if recommended and medically appropriate.
   Coverage of fertility medications shall not be less favorable than coverage for any other prescription medications under the plan. Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations on coverage for the diagnosis of and treatment for infertility and preservation services shall not be any less favorable than those imposed on benefits for services covered under the plan that are not related to infertility.
   The bill provides an exception for a religious employer to request an exclusion from the required coverage and requires the religious employer to provide notice to employees of the exclusion.
   The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2025, by the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance not subject to the bill.
   The commissioner of insurance may adopt rules to administer the bill.