House File 333 - Introduced HOUSE FILE 333 BY STECKMAN , ANDERSON , McCONKEY , SUNDE , WINCKLER , EHLERT , B. MEYER , DONAHUE , WESSEL-KROESCHELL , ABDUL-SAMAD , HUNTER , BROWN-POWERS , and KONFRST A BILL FOR An Act relating to health care coverage benefits for the 1 diagnosis and treatment of infertility, and for fertility 2 preservation services, and including applicability 3 provisions. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1854YH (3) 89 ko/rn

H.F. 333 Section 1. NEW SECTION . 514C.36 Infertility. 1 1. As used in this section, unless the context otherwise 2 requires: 3 a. “Cost-sharing” means any coverage limit, copayment, 4 coinsurance, deductible, or other out-of-pocket expense 5 obligation imposed on a covered person by a policy, contract, 6 or plan providing for third-party payment or prepayment of 7 health or medical expenses. 8 b. “Covered person” means a policyholder, subscriber, or 9 other person participating in a policy, contract, or plan that 10 provides for third-party payment or prepayment of health or 11 medical expenses. 12 c. “Diagnosis and treatment for infertility” means health 13 care services or prescription drugs recommended by an 14 individual’s health care professional and that are consistent 15 with the established medical practices or published guidelines 16 of the American college of obstetricians and gynecologists, 17 or of the American society for reproductive medicine, for the 18 diagnosis and treatment of infertility. 19 d. “Fertility preservation services” means health 20 care services recommended by an individual’s health care 21 professional and that are consistent with the established 22 medical practices or published guidelines of the American 23 society for reproductive medicine, or of the American society 24 of clinical oncology, for the treatment of an individual who 25 has a medical condition or is expected to undergo medication 26 therapy, surgery, radiation, chemotherapy, or other medical 27 treatment that creates a risk of impairment of the individual’s 28 fertility. 29 e. “Health care professional” means the same as defined in 30 section 514J.102. 31 f. “Health care services” means services for the diagnosis, 32 prevention, treatment, cure, or relief of a health condition, 33 illness, injury, or disease. 34 g. “Infertility” means a health condition, illness, injury, 35 -1- LSB 1854YH (3) 89 ko/rn 1/ 4

H.F. 333 or disease characterized by any of the following: 1 (1) The failure to establish a pregnancy or to carry a 2 pregnancy to live birth after regular, unprotected sexual 3 intercourse. 4 (2) The inability of an individual to reproduce without 5 medical intervention either as a single individual or with a 6 partner. 7 (3) A health care professional’s diagnosis based on an 8 individual’s sex, age, medical history, sexual history, or 9 reproductive history; or a physical examination or diagnostic 10 testing. 11 2. Notwithstanding the uniformity of treatment requirements 12 of section 514C.6, a policy, contract, or plan providing for 13 third-party payment or prepayment of health or medical expenses 14 shall provide coverage for the diagnosis and treatment of 15 infertility, and for fertility preservation services. 16 3. Coverage shall not be subject to cost-sharing, 17 waiting periods, or exclusions that are different than the 18 cost-sharing, waiting periods, or exclusions that a policy, 19 contract, or plan imposes for other health or medical expenses 20 covered under the policy, contract, or plan. 21 4. a. This section shall apply to the following classes of 22 third-party payment provider contracts, policies, or plans: 23 (1) Individual or group accident and sickness insurance 24 providing coverage on an expense-incurred basis. 25 (2) An individual or group hospital or medical service 26 contract issued pursuant to chapter 509, 514, or 514A. 27 (3) An individual or group health maintenance organization 28 contract regulated under chapter 514B. 29 (4) A plan established for public employees pursuant to 30 chapter 509A. 31 (5) The medical assistance program established pursuant 32 to chapter 249A, including a managed care organization acting 33 pursuant to a contract with the department of human services to 34 provide coverage to medical assistance program members. 35 -2- LSB 1854YH (3) 89 ko/rn 2/ 4

H.F. 333 b. This section shall not apply to accident-only, specified 1 disease, short-term hospital or medical, hospital confinement 2 indemnity, credit, dental, vision, Medicare supplement, 3 long-term care, basic hospital and medical-surgical expense 4 coverage as defined by the commissioner of insurance, 5 disability income insurance coverage, coverage issued as a 6 supplement to liability insurance, workers’ compensation or 7 similar insurance, or automobile medical payment insurance. 8 5. The commissioner of insurance shall adopt rules pursuant 9 to chapter 17A to administer this section. 10 Sec. 2. APPLICABILITY. This Act applies to third-party 11 payment provider contracts, policies, or plans delivered, 12 issued for delivery, continued, or renewed in this state on or 13 after January 1, 2022. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to health care coverage benefits for the 18 diagnosis and treatment of infertility, and for fertility 19 preservation services. 20 The bill defines “infertility” as a health condition, 21 illness, injury, or disease characterized by the failure to 22 establish a pregnancy or to carry a pregnancy to live birth 23 after regular, unprotected sexual intercourse; or the inability 24 of an individual to reproduce without medical intervention 25 either as a single individual or with a partner; or a health 26 care professional’s diagnosis based on a covered person’s sex, 27 age, medical history, sexual history, or reproductive history; 28 or a physical examination or diagnostic testing. 29 The bill defines “diagnosis and treatment for infertility” 30 as health care services or prescription drugs recommended by an 31 individual’s health care professional and that are consistent 32 with the established medical practices or published guidelines 33 of the American college of obstetricians and gynecologists, 34 or of the American society for reproductive medicine, for 35 -3- LSB 1854YH (3) 89 ko/rn 3/ 4

H.F. 333 the diagnosis and treatment of infertility. “Health care 1 professional” is defined in the bill. 2 “Fertility preservation services” is defined in the bill 3 as health care services recommended by a individual’s health 4 care professional and that are consistent with the established 5 medical practices or published guidelines of the American 6 society for reproductive medicine, or of the American society 7 of clinical oncology, for the treatment of an individual who 8 has a medical condition or is expected to undergo medication 9 therapy, surgery, radiation, chemotherapy, or other medical 10 treatment that creates a risk of impairment of the individual’s 11 fertility. 12 The bill requires a health carrier that offers individual, 13 group, or small group contracts, policies, or plans in this 14 state that provide for third-party payment or prepayment 15 of health or medical expenses to provide coverage for the 16 diagnosis and treatment of infertility, and for fertility 17 preservation services. The coverage cannot be subject to 18 cost-sharing, waiting periods, or exclusions that are different 19 than the cost-sharing, waiting periods, or exclusions that the 20 policy, contract, or plan imposes for other covered health or 21 medical expenses. 22 The bill applies to the third-party payment providers 23 enumerated in the bill. The bill specifies the types of 24 specialized health-related insurance which are not subject to 25 the coverage requirements of the bill. 26 The commissioner of insurance must adopt rules to administer 27 the requirements of the bill. 28 The bill applies to third-party payment provider contracts, 29 policies, or plans delivered, issued for delivery, continued, 30 or renewed in this state on or after January 1, 2022. 31 -4- LSB 1854YH (3) 89 ko/rn 4/ 4