S T A T E O F N E W Y O R K
________________________________________________________________________
2669
2011-2012 Regular Sessions
I N S E N A T E
January 28, 2011
___________
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 28 to read as follows:
(28) (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.
LBD07241-01-1
S. 2669 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 17 to read as follows:
(17)(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. 2669 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 (hh) to read as follows:
(HH) (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. 2669 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.