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

                                  10137

                          I N  A S S E M B L Y

                              May 12, 2016
                               ___________

Introduced  by M. of A. SIMOTAS -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance law, in relation to insurance coverage  of
  in vitro fertilization and other fertility preservation treatments

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

  Section 1. The insurance law is amended by adding a new  section  3242
to read as follows:
  S  3242.  IN  VITRO  FERTILIZATION AND FERTILITY-RELATED PROVISIONS IN
POLICIES. (A) EXCEPT AS PROVIDED IN SUBSECTION (C) OF THIS  SECTION,  NO
POLICY OF GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE SHALL BE DELIV-
ERED  OR ISSUED FOR DELIVERY IN THIS STATE TO A GROUP UNLESS IT CONTAINS
IN SUBSTANCE THE FOLLOWING PROVISIONS OR PROVISIONS WHICH IN THE OPINION
OF THE SUPERINTENDENT ARE MORE FAVORABLE TO THE HOLDERS OF SUCH  CERTIF-
ICATES  OR  NOT  LESS  FAVORABLE TO THE HOLDERS OF SUCH CERTIFICATES AND
MORE FAVORABLE TO POLICYHOLDERS:
  (1)  COVERAGE  OF  DIAGNOSTIC  AND  TREATMENT  PROCEDURES,   INCLUDING
PRESCRIPTION DRUGS AND IN VITRO FERTILIZATION, USED IN THE DIAGNOSIS AND
TREATMENT OF INFERTILITY. AS USED IN THIS SECTION, "INFERTILITY" MEANS A
DISEASE  CHARACTERIZED BY THE INCAPACITY TO IMPREGNATE ANOTHER PERSON OR
TO CONCEIVE, AS DIAGNOSED (A) BY A PHYSICIAN LICENSED TO PRACTICE  MEDI-
CINE  IN  THE STATE, OR (B) BY THE FAILURE TO ESTABLISH A CLINICAL PREG-
NANCY AFTER TWELVE MONTHS OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE.
  (2) COVERAGE OF MEDICALLY NECESSARY EXPENSES  FOR  STANDARD  FERTILITY
PRESERVATION SERVICES WHEN A NECESSARY MEDICAL TREATMENT MAY DIRECTLY OR
INDIRECTLY  CAUSE IATROGENIC INFERTILITY TO A COVERED PERSON. AS USED IN
THIS SECTION, "IATROGENIC INFERTILITY" MEANS AN IMPAIRMENT OF  FERTILITY
BY SURGERY, RADIATION, CHEMOTHERAPY OR OTHER MEDICAL TREATMENT AFFECTING
REPRODUCTIVE ORGANS OR PROCESSES.
  POLICIES  WHICH  COVER  HOSPITAL  SERVICES  ONLY,  MEDICAL OR SURGICAL
SERVICES ONLY, OR PRESCRIPTION DRUGS ONLY, SHALL  PROVIDE  FERTILITY-RE-
LATED COVERAGE TO THE EXTENT THEY FALL WITHIN THE CATEGORIES OF SERVICES
OTHERWISE COVERED.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14892-01-6
              

A. 10137                            2

  (B) IN DETERMINING COVERAGE PURSUANT TO THIS SECTION, AN INSURER SHALL
NOT DISCRIMINATE BASED ON AN INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRES-
ENT  OR  PREDICTED  DISABILITY, DEGREE OF MEDICAL DEPENDENCY, QUALITY OF
LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
INCLUDING AGE, SEX, SEXUAL ORIENTATION OR MARITAL STATUS.
  (C) THE REQUIREMENTS OF THIS SECTION SHALL NOT APPLY TO GROUP OR BLAN-
KET  ACCIDENT  AND  HEALTH  INSURANCE POLICIES ISSUED IN THE SMALL GROUP
MARKET.
  S  2. Subparagraph (C) of paragraph 6 of  subsection  (k)  of  section
3221  of the insurance law, as amended by section 1 of part K of chapter
82 of the laws of 2002, is amended to read as follows:
  (C)  Coverage  of  diagnostic  and  treatment  procedures,   including
prescription  drugs,  used in the diagnosis and treatment of infertility
as required by subparagraphs (A) and (B)  of  this  paragraph  shall  be
provided in accordance with the provisions of this subparagraph.
  (i)  [Coverage  shall  be  provided  for persons whose ages range from
twenty-one through forty-four years, provided that nothing herein  shall
preclude  the  provision  of  coverage  to persons whose age is below or
above such range.
  (ii)] Diagnosis and treatment of infertility shall  be  prescribed  as
part  of  a  physician's  overall  plan  of care and consistent with the
guidelines for coverage as referenced in this subparagraph.
  [(iii)] (II) Coverage may be subject to co-payments,  coinsurance  and
deductibles  as  may  be deemed appropriate by the superintendent and as
are consistent with those established for other benefits within a  given
policy.
  [(iv)]  (III)  Coverage shall be limited to those individuals who have
been previously covered under the policy for a period of not  less  than
twelve  months,  provided  that  for  the  purposes of this subparagraph
"period of not less than twelve months" shall be determined by calculat-
ing such time from either the date the insured was first  covered  under
the  existing policy or from the date the insured was first covered by a
previously in-force converted policy, whichever is earlier.
  [(v)] (IV) Coverage shall not be required to include the diagnosis and
treatment of infertility in connection with: (I)  [in  vitro  fertiliza-
tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
transfers;  (II)]  the reversal of elective sterilizations; [(III)] (II)
sex change procedures; [(IV)] (III) cloning; or [(V)]  (IV)  medical  or
surgical  services  or  procedures that are deemed to be experimental in
accordance with clinical guidelines referenced in clause [(vi)]  (V)  of
this subparagraph.
  [(vi)]  (V)  The superintendent, in consultation with the commissioner
of health, shall promulgate regulations which shall stipulate the guide-
lines and standards which shall be used in carrying out  the  provisions
of this subparagraph, which shall include:
  (I)  The determination of "infertility" in accordance with the [stand-
ards and guidelines established and adopted by the American  College  of
Obstetricians  and  Gynecologists and the American Society for Reproduc-
tive Medicine] DEFINITIONS OF INFERTILITY AND IATROGENIC INFERTILITY  IN
PARAGRAPHS  ONE  AND TWO OF SUBSECTION (A) OF SECTION THREE THOUSAND TWO
HUNDRED FORTY-TWO OF THIS CHAPTER;
  (II) The identification of experimental procedures and treatments  not
covered  for  the  diagnosis  and treatment of infertility determined in
accordance with the standards and guidelines established and adopted  by
the American College of Obstetricians and Gynecologists and the American
Society for Reproductive Medicine;

A. 10137                            3

  (III)  The  identification  of  the  required training, experience and
other standards for health care providers for the  provision  of  proce-
dures  and  treatments  for  the  diagnosis and treatment of infertility
determined in accordance with the standards and  guidelines  established
and  adopted  by the American College of Obstetricians and Gynecologists
and the American Society for Reproductive Medicine; and
  (IV) The determination of appropriate medical candidates by the treat-
ing physician in accordance with the  standards  and  guidelines  estab-
lished and adopted by the American College of Obstetricians and Gynecol-
ogists and/or the American Society for Reproductive Medicine.
  S  3.  Paragraph  3 of subsection (s) of section 4303 of the insurance
law, as amended by section 2 of part K of chapter  82  of  the  laws  of
2002, is amended to read as follows:
  (3)   Coverage  of  diagnostic  and  treatment  procedures,  including
prescription drugs used in the diagnosis and treatment of infertility as
required by paragraphs one and two of this subsection shall be  provided
in accordance with this paragraph.
  (A)  [Coverage  shall  be  provided  for persons whose ages range from
twenty-one through forty-four years, provided that nothing herein  shall
preclude  the  provision  of  coverage  to persons whose age is below or
above such range.
  (B)] Diagnosis and treatment of infertility  shall  be  prescribed  as
part  of  a  physician's  overall  plan  of care and consistent with the
guidelines for coverage as referenced in this paragraph.
  [(C)] (B) Coverage may be  subject  to  co-payments,  coinsurance  and
deductibles  as  may  be deemed appropriate by the superintendent and as
are consistent with those established for other benefits within a  given
policy.
  [(D)] (C) Coverage shall be limited to those individuals who have been
previously covered under the policy for a period of not less than twelve
months,  provided that for the purposes of this paragraph "period of not
less than twelve months" shall be determined by  calculating  such  time
from  either  the  date the insured was first covered under the existing
policy or from the date the insured was first covered  by  a  previously
in-force converted policy, whichever is earlier.
  [(E)]  (D) Coverage shall not be required to include the diagnosis and
treatment of infertility in connection with: (i)  [in  vitro  fertiliza-
tion, gamete intrafallopian tube transfers or zygote intrafallopian tube
transfers;  (ii)]  the reversal of elective sterilizations; [(iii)] (II)
sex change procedures; [(iv)] (III) cloning; or [(v)]  (IV)  medical  or
surgical  services  or  procedures that are deemed to be experimental in
accordance with clinical guidelines referenced in subparagraph [(F)] (E)
of this paragraph.
  [(F)] (E) The superintendent, in consultation with the commissioner of
health, shall promulgate regulations which shall  stipulate  the  guide-
lines  and  standards which shall be used in carrying out the provisions
of this paragraph, which shall include:
  (i) The determination of "infertility" in accordance with the  [stand-
ards  and  guidelines established and adopted by the American College of
Obstetricians and Gynecologists and the American Society  for  Reproduc-
tive  Medicine] DEFINITIONS OF INFERTILITY AND IATROGENIC INFERTILITY IN
PARAGRAPHS ONE AND TWO OF SUBSECTION (A) OF SECTION THREE  THOUSAND  TWO
HUNDRED FORTY-TWO OF THIS CHAPTER;
  (ii)  The identification of experimental procedures and treatments not
covered for the diagnosis and treatment  of  infertility  determined  in
accordance  with the standards and guidelines established and adopted by

A. 10137                            4

the American College of Obstetricians and Gynecologists and the American
Society for Reproductive Medicine;
  (iii)  The  identification  of  the  required training, experience and
other standards for health care providers for the  provision  of  proce-
dures  and  treatments  for  the  diagnosis and treatment of infertility
determined in accordance with the standards and  guidelines  established
and  adopted  by the American College of Obstetricians and Gynecologists
and the American Society for Reproductive Medicine; and
  (iv) The determination of appropriate medical candidates by the treat-
ing physician in accordance with the  standards  and  guidelines  estab-
lished and adopted by the American College of Obstetricians and Gynecol-
ogists and/or the American Society for Reproductive Medicine.
  S 4. This act shall take effect immediately.