S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   446

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2009
                               ___________

Introduced  by  Sen.  KRUGER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  health  insurance
  coverage for diagnostic testing and treatment for infertility

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (i) of section 3216  of  the  insurance  law  is
amended by adding a new paragraph 26 to read as follows:
  (26)  (A)  EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE
FOR  THE  DIAGNOSIS  AND  TREATMENT  OF  INFERTILITY, INCLUDING, BUT NOT
LIMITED TO, DRUG THERAPY, ARTIFICIAL INSEMINATION, IN  VITRO  FERTILIZA-
TION,   INTRACYTOPLASMIC   SPERM   INJECTION,  GAMETE  DONATION,  EMBRYO
DONATION, ASSISTED HATCHING, UTERINE  EMBRYO  LAVAGE,  EMBRYO  TRANSFER,
GAMETE  INTRAFALLOPIAN  TUBE TRANSFER, ZYGOTE INTRAFALLOPIAN TUBE TRANS-
FER, LOW TUBAL OVUM TRANSFER, GAMETE PRESERVATION,  EMBRYO  PRESERVATION
AND  ANY  OTHER  MEDICALLY  OR SURGICALLY INDICATED SERVICE OR PROCEDURE
THAT IS USED TO TREAT INFERTILITY OR INDUCE PREGNANCY,  EXCEPT  THAT  IF
THE  GROUP  OR  ENTITY  ON  WHOSE  BEHALF THE POLICY IS ISSUED IS, OR IS
CONTROLLED BY, A RELIGIOUS OR DENOMINATIONAL GROUP OR ENTITY, NOTHING IN
THIS SECTION SHALL REQUIRE THE POLICY TO COVER ANY DIAGNOSIS  OR  TREAT-
MENT THAT IS CONTRARY TO THE RELIGIOUS TENETS OF SUCH GROUP OR ENTITY.
  (B)  THE COVERAGE REQUIRED UNDER SUBPARAGRAPH (A) OF THIS PARAGRAPH IS
SUBJECT TO THE FOLLOWING CONDITIONS:
  (I) THE TERMS OF SUCH COVERAGE, INCLUDING, BUT NOT LIMITED TO, CO-PAY-
MENTS, DEDUCTIBLES AND ACCESS  TO  OUT-OF-NETWORK  PROVIDERS,  SHALL  BE
CONSISTENT  WITH  THE  COVERAGE PROVIDED IN THE POLICY FOR THE SPECIALTY
TREATMENT OF ANY OTHER DISEASE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD03607-01-9

S. 446                              2

  (II) COVERAGE FOR PROCEDURES FOR IN  VITRO  FERTILIZATION,  INTRACYTO-
PLASMIC  SPERM  INJECTION,  ASSISTED  HATCHING,  GAMETE DONATION, EMBRYO
DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE
INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF:
  (A)  THE  COVERED  INDIVIDUAL  HAS  BEEN UNABLE TO ATTAIN OR SUSTAIN A
SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI-
ATE INFERTILITY TREATMENTS FOR WHICH COVERAGE  IS  AVAILABLE  UNDER  THE
POLICY, PLAN OR CONTRACT;
  (B)  THE  COVERED  INDIVIDUAL  HAS NOT UNDERGONE FOUR COMPLETED OOCYTE
RETRIEVALS, EACH OF WHICH HAS RESULTED IN AT LEAST ONE COMPLETED  EMBRYO
TRANSFER,  EXCEPT  THAT  IF  A  LIVE  BIRTH  FOLLOWS  A COMPLETED OOCYTE
RETRIEVAL AND EMBRYO TRANSFER, THEN COVERAGE SHALL BE REQUIRED  FOR  TWO
ADDITIONAL COMPLETED OOCYTE RETRIEVALS EACH OF WHICH RESULTS IN AT LEAST
ONE COMPLETED EMBRYO TRANSFER; AND
  (C) THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM TO
THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR IN VITRO
FERTILIZATION  CLINICS OR TO THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDI-
CINE MINIMAL STANDARDS FOR PROGRAMS OF IN VITRO FERTILIZATION.
  (III) FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEANS THE  INABILITY
TO  CONCEIVE  AFTER  ONE  YEAR  OF UNPROTECTED SEXUAL INTERCOURSE OR THE
INABILITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A  DEMON-
STRATED CONDITION IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A LICENSED
PHYSICIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A PREGNANCY
TO A LIVE BIRTH.
  S 2. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 15 to read as follows:
  (15)(A)  EVERY  POLICY  DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES  COVERAGE  FOR  PHYSICIAN
SERVICES  IN  A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR
MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE
FOR  THE  DIAGNOSIS  AND  TREATMENT  OF  INFERTILITY, INCLUDING, BUT NOT
LIMITED TO, DRUG THERAPY, ARTIFICIAL INSEMINATION, IN  VITRO  FERTILIZA-
TION,   INTRACYTOPLASMIC   SPERM   INJECTION,  GAMETE  DONATION,  EMBRYO
DONATION, ASSISTED HATCHING, UTERINE  EMBRYO  LAVAGE,  EMBRYO  TRANSFER,
GAMETE  INTRAFALLOPIAN  TUBE TRANSFER, ZYGOTE INTRAFALLOPIAN TUBE TRANS-
FER, LOW TUBAL OVUM TRANSFER, GAMETE PRESERVATION,  EMBRYO  PRESERVATION
AND  ANY  OTHER  MEDICALLY  OR SURGICALLY INDICATED SERVICE OR PROCEDURE
THAT IS USED TO TREAT INFERTILITY OR INDUCE PREGNANCY,  EXCEPT  THAT  IF
THE  GROUP  OR  ENTITY  ON  WHOSE  BEHALF THE POLICY IS ISSUED IS, OR IS
CONTROLLED BY, A RELIGIOUS OR DENOMINATIONAL GROUP OR ENTITY, NOTHING IN
THIS SECTION SHALL REQUIRE THE POLICY TO COVER ANY DIAGNOSIS  OR  TREAT-
MENT THAT IS CONTRARY TO THE RELIGIOUS TENETS OF SUCH GROUP OR ENTITY.
  (B)  THE COVERAGE REQUIRED UNDER SUBPARAGRAPH (A) OF THIS PARAGRAPH IS
SUBJECT TO THE FOLLOWING CONDITIONS:
  (I) THE TERMS OF SUCH COVERAGE, INCLUDING, BUT NOT LIMITED TO, CO-PAY-
MENTS, DEDUCTIBLES AND ACCESS  TO  OUT-OF-NETWORK  PROVIDERS,  SHALL  BE
CONSISTENT  WITH  THE  COVERAGE PROVIDED IN THE POLICY FOR THE SPECIALTY
TREATMENT OF ANY OTHER DISEASE.
  (II) COVERAGE FOR PROCEDURES FOR IN  VITRO  FERTILIZATION,  INTRACYTO-
PLASMIC  SPERM  INJECTION,  ASSISTED  HATCHING,  GAMETE DONATION, EMBRYO
DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE
INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF:
  (A) THE COVERED INDIVIDUAL HAS BEEN UNABLE  TO  ATTAIN  OR  SUSTAIN  A
SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI-
ATE  INFERTILITY  TREATMENTS  FOR  WHICH COVERAGE IS AVAILABLE UNDER THE
POLICY, PLAN OR CONTRACT;

S. 446                              3

  (B) THE COVERED INDIVIDUAL HAS NOT  UNDERGONE  FOUR  COMPLETED  OOCYTE
RETRIEVALS,  EACH OF WHICH HAS RESULTED IN AT LEAST ONE COMPLETED EMBRYO
TRANSFER, EXCEPT THAT  IF  A  LIVE  BIRTH  FOLLOWS  A  COMPLETED  OOCYTE
RETRIEVAL  AND  EMBRYO TRANSFER, THEN COVERAGE SHALL BE REQUIRED FOR TWO
ADDITIONAL COMPLETED OOCYTE RETRIEVALS EACH OF WHICH RESULTS IN AT LEAST
ONE COMPLETED EMBRYO TRANSFER; AND
  (C) THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM TO
THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR IN VITRO
FERTILIZATION  CLINICS OR TO THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDI-
CINE MINIMAL STANDARDS FOR PROGRAMS OF IN VITRO FERTILIZATION.
  (III) FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEANS THE  INABILITY
TO  CONCEIVE  AFTER  ONE  YEAR  OF UNPROTECTED SEXUAL INTERCOURSE OR THE
INABILITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A  DEMON-
STRATED CONDITION IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A LICENSED
PHYSICIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A PREGNANCY
TO A LIVE BIRTH.
  S  3.  Section  4303  of  the insurance law is amended by adding a new
subsection (ff) to read as follows:
  (FF) (1) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN  THIS  STATE
WHICH  PROVIDES  MEDICAL  COVERAGE  THAT INCLUDES COVERAGE FOR PHYSICIAN
SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH  PROVIDES  MAJOR
MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE
FOR THE DIAGNOSIS AND  TREATMENT  OF  INFERTILITY,  INCLUDING,  BUT  NOT
LIMITED  TO,  DRUG THERAPY, ARTIFICIAL INSEMINATION, IN VITRO FERTILIZA-
TION,  INTRACYTOPLASMIC  SPERM  INJECTION,   GAMETE   DONATION,   EMBRYO
DONATION,  ASSISTED  HATCHING,  UTERINE  EMBRYO LAVAGE, EMBRYO TRANSFER,
GAMETE INTRAFALLOPIAN TUBE TRANSFER, ZYGOTE INTRAFALLOPIAN  TUBE  TRANS-
FER,  LOW  TUBAL OVUM TRANSFER, GAMETE PRESERVATION, EMBRYO PRESERVATION
AND ANY OTHER MEDICALLY OR SURGICALLY  INDICATED  SERVICE  OR  PROCEDURE
THAT  IS  USED  TO TREAT INFERTILITY OR INDUCE PREGNANCY, EXCEPT THAT IF
THE GROUP OR ENTITY  ON  WHOSE  BEHALF  THE  POLICY  ISSUED  IS,  OR  IS
CONTROLLED BY, A RELIGIOUS OR DENOMINATIONAL GROUP OR ENTITY, NOTHING IN
THIS  SECTION  SHALL REQUIRE THE POLICY TO COVER ANY DIAGNOSIS OR TREAT-
MENT THAT IS CONTRARY TO THE RELIGIOUS TENETS OF SUCH GROUP OR ENTITY.
  (2) THE COVERAGE REQUIRED UNDER PARAGRAPH ONE OF  THIS  SUBSECTION  IS
SUBJECT TO THE FOLLOWING CONDITIONS:
  (A) THE TERMS OF SUCH COVERAGE, INCLUDING, BUT NOT LIMITED TO, CO-PAY-
MENTS,  DEDUCTIBLES  AND  ACCESS  TO  OUT-OF-NETWORK PROVIDERS, SHALL BE
CONSISTENT WITH THE COVERAGE PROVIDED IN THE POLICY FOR  THE  SPECIALITY
TREATMENT OF ANY OTHER DISEASE.
  (B)  COVERAGE  FOR  PROCEDURES  FOR IN VITRO FERTILIZATION, INTRACYTO-
PLASMIC SPERM INJECTION,  ASSISTED  HATCHING,  GAMETE  DONATION,  EMBRYO
DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE
INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF:
  (I)  THE  COVERED  INDIVIDUAL  HAS  BEEN UNABLE TO ATTAIN OR SUSTAIN A
SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI-
ATE INFERTILITY TREATMENTS FOR WHICH COVERAGE  IS  AVAILABLE  UNDER  THE
POLICY, PLAN OR CONTRACT;
  (II)  THE  COVERED  INDIVIDUAL HAS NOT UNDERGONE FOUR COMPLETED OOCYTE
RETRIEVALS, EACH OF WHICH HAS RESULTED IN AT LEAST ONE COMPLETED  EMBRYO
TRANSFER,  EXCEPT  THAT  IF  A  LIVE  BIRTH  FOLLOWS  A COMPLETED OOCYTE
RETRIEVAL AND EMBRYO TRANSFER, THEN COVERAGE SHALL BE REQUIRED  FOR  TWO
ADDITIONAL COMPLETED OOCYTE RETRIEVALS EACH OF WHICH RESULTS IN AT LEAST
ONE COMPLETED EMBRYO TRANSFER; AND
  (III)  THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM
TO THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY  GUIDELINES  FOR  IN

S. 446                              4

VITRO  FERTILIZATION CLINICS OR TO THE AMERICAN SOCIETY FOR REPRODUCTIVE
MEDICINE MINIMAL STANDARDS FOR PROGRAMS OF IN VITRO FERTILIZATION.
  (C)  FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEAN THE INABILITY TO
CONCEIVE AFTER ONE YEAR OF UNPROTECTED SEXUAL INTERCOURSE OR THE INABIL-
ITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A  DEMONSTRATED
CONDITION  IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A LICENSED PHYSI-
CIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A PREGNANCY TO A
LIVE BIRTH.
  S 4. Subparagraph (B) of paragraph 11 of  subsection  (l)  of  section
3221  of  the  insurance  law,  as amended by chapter 554 of the laws of
2002, is amended to read as follows:
  (B) Such coverage may NOT be subject to annual deductibles and coinsu-
rance [as may be deemed appropriate by the  superintendent  and  as  are
consistent  with  those  established  for  other benefits within a given
policy].
  S 5. The closing paragraph of paragraph 1 of subsection (p) of section
4303 of the insurance law, as amended by chapter  554  of  the  laws  of
2002, is amended to read as follows:
  The  coverage  required in this paragraph may NOT be subject to annual
deductibles and coinsurance [as may be deemed appropriate by the  super-
intendent  and  as are consistent with those established for other bene-
fits within a given policy].
  S 6. Subparagraph (C) of paragraph 14 of  subsection  (l)  of  section
3221  of  the  insurance  law,  as amended by chapter 554 of the laws of
2002, is amended to read as follows:
  (C) Such coverage may NOT be subject to annual deductibles and coinsu-
rance [as may be deemed appropriate by the  superintendent  and  as  are
consistent  with  those  established  for  other benefits within a given
policy].
  S 7. Paragraph 1 of subsection (t) of section 4303  of  the  insurance
law,  as  amended by chapter 554 of the laws of 2002, is amended to read
as follows:
  (1) A medical expense indemnity corporation, a hospital service corpo-
ration or a health  service  corporation  which  provides  coverage  for
hospital, surgical, or medical care shall provide coverage for an annual
cervical cytology screening for cervical cancer and its precursor states
for  women  aged eighteen and older. Such coverage may NOT be subject to
annual deductibles and coinsurance [as may be deemed appropriate by  the
superintendent  and  as  are consistent with those established for other
benefits within a given contract].
  S 8. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies issued, renewed, modified or altered on or after such effective
date.