S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2817
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 25, 2019
                                ___________
 
 Introduced  by  M.  of  A.  SIMOTAS,  BICHOTTE, QUART, BRONSON, SOLAGES,
   BRAUNSTEIN, STECK, SEAWRIGHT, SIMON, PAULIN, BARRETT, HEVESI,  LAVINE,
   CYMBROWITZ,  MOSLEY,  BUCHWALD,  DINOWITZ,  ROZIC, L. ROSENTHAL, OTIS,
   LIFTON, JEAN-PIERRE, WRIGHT, WEPRIN, ZEBROWSKI --  Multi-Sponsored  by
   --  M.  of  A.  ENGLEBRIGHT,  LENTOL  -- read once and referred to the
   Committee 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. Paragraph 13 of subsection  (i)  of  section  3216  of  the
 insurance  law is amended by adding three new subparagraphs (C), (D) and
 (E) to read as follows:
   (C) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS  STATE  THAT
 PROVIDES  COVERAGE  FOR HOSPITAL, SURGICAL OR MEDICAL CARE SHALL PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (D)  (I)  FOR  THE  PURPOSES  OF  SUBPARAGRAPH  (C) OF THIS PARAGRAPH,
 "INFERTILITY" MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPAC-
 ITY TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR  DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II)  BY  THE  FAILURE  TO  ESTABLISH  A CLINICAL PREGNANCY AFTER TWELVE
 MONTHS OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER  SIX  MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.
   (II)  FOR  THE PURPOSES OF SUBPARAGRAPH (C) OF THIS PARAGRAPH, "IATRO-
 GENIC INFERTILITY" MEANS AN IMPAIRMENT OF FERTILITY  BY  SURGERY,  RADI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01402-02-9
              

 A. 2817                             2
 
 ATION,  CHEMOTHERAPY  OR  OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE
 ORGANS OR PROCESSES.
   (E) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   §  2.  Paragraph  6 of subsection (k) of section 3221 of the insurance
 law is amended by adding three new subparagraphs (E),  (F)  and  (G)  to
 read as follows:
   (E)  EVERY GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
 THAT PROVIDES HOSPITAL,  SURGICAL  OR  MEDICAL  COVERAGE  SHALL  PROVIDE
 COVERAGE FOR:
   (I) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (II) STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT  MAY  DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY TO A
 COVERED PERSON.
   (F) (I) FOR THE  PURPOSES  OF  SUBPARAGRAPH  (E)  OF  THIS  PARAGRAPH,
 "INFERTILITY" MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPAC-
 ITY  TO IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETER-
 MINED (I) BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR
 (II) BY THE FAILURE TO  ESTABLISH  A  CLINICAL  PREGNANCY  AFTER  TWELVE
 MONTHS  OF  REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS
 OF REGULAR, UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIR-
 TY-FIVE YEARS OF AGE OR OLDER.
   (II) FOR THE PURPOSES OF SUBPARAGRAPH (E) OF THIS  PARAGRAPH,  "IATRO-
 GENIC  INFERTILITY"  MEANS  AN IMPAIRMENT OF FERTILITY BY SURGERY, RADI-
 ATION, CHEMOTHERAPY OR OTHER MEDICAL  TREATMENT  AFFECTING  REPRODUCTIVE
 ORGANS OR PROCESSES.
   (G) NO INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH SHALL DISCRIMI-
 NATE BASED ON A COVERED INDIVIDUAL'S EXPECTED LENGTH OF LIFE, PRESENT OR
 PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, PERCEIVED QUALITY OF
 LIFE, OR OTHER HEALTH CONDITIONS, NOR BASED ON PERSONAL CHARACTERISTICS,
 INCLUDING AGE, SEX, SEXUAL ORIENTATION, MARITAL STATUS OR GENDER IDENTI-
 TY.
   §  3.  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  by
 adding three new paragraphs (5), (6) and (7) to read as follows:
   (5)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION,
 HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION FOR  DELIVERY
 IN THIS STATE THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL COVERAGE SHALL
 PROVIDE COVERAGE FOR:
   (A) IN VITRO FERTILIZATION USED IN THE TREATMENT OF INFERTILITY; AND
   (B)  STANDARD FERTILITY PRESERVATION SERVICES WHEN A NECESSARY MEDICAL
 TREATMENT MAY DIRECTLY OR INDIRECTLY CAUSE IATROGENIC INFERTILITY  TO  A
 COVERED PERSON.
   (6) (A) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "INFER-
 TILITY"  MEANS A DISEASE OR CONDITION CHARACTERIZED BY THE INCAPACITY TO
 IMPREGNATE ANOTHER PERSON OR TO CONCEIVE, AS DIAGNOSED OR DETERMINED (I)
 BY A PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE, OR  (II)  BY
 THE  FAILURE  TO  ESTABLISH  A CLINICAL PREGNANCY AFTER TWELVE MONTHS OF
 REGULAR, UNPROTECTED SEXUAL INTERCOURSE, OR AFTER SIX MONTHS OF REGULAR,
 UNPROTECTED SEXUAL INTERCOURSE IN THE CASE OF A FEMALE THIRTY-FIVE YEARS
 OF AGE OR OLDER.

 A. 2817                             3
 
   (B) FOR THE PURPOSES OF PARAGRAPH FIVE OF THIS SUBSECTION, "IATROGENIC
 INFERTILITY" MEANS AN IMPAIRMENT OF  FERTILITY  BY  SURGERY,  RADIATION,
 CHEMOTHERAPY OR OTHER MEDICAL TREATMENT AFFECTING REPRODUCTIVE ORGANS OR
 PROCESSES.
   (7)  NO MEDICAL EXPENSE INDEMNITY CORPORATION, HOSPITAL SERVICE CORPO-
 RATION OR HEALTH  SERVICE  CORPORATION  PROVIDING  COVERAGE  UNDER  THIS
 SUBSECTION  SHALL  DISCRIMINATE BASED ON A COVERED INDIVIDUAL'S EXPECTED
 LENGTH OF LIFE, PRESENT  OR  PREDICTED  DISABILITY,  DEGREE  OF  MEDICAL
 DEPENDENCY,  PERCEIVED  QUALITY OF LIFE, OR OTHER HEALTH CONDITIONS, NOR
 BASED ON PERSONAL CHARACTERISTICS, INCLUDING  AGE,  SEX,  SEXUAL  ORIEN-
 TATION, MARITAL STATUS OR GENDER IDENTITY.
   § 4. 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) 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  calculating  such
 time from either the date the insured was first covered under the exist-
 ing policy or from the date the insured was first covered by a previous-
 ly in-force converted policy, whichever is earlier.
   (v)] (III) 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)] (IV) of
 this subparagraph.
   [(vi)] (IV) 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;
   (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. 2817                             4
 
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   [(III)]  (II)  The identification of the required training, experience
 and other standards for health  care  providers  for  the  provision  of
 procedures 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)]  (III)  The  determination of appropriate medical candidates by
 the treating physician in accordance with the standards  and  guidelines
 established  and  adopted  by  the American College of Obstetricians and
 Gynecologists and/or the American Society for Reproductive Medicine.
   § 5. 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) 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)]  (C)  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)] (D)
 of this paragraph.
   [(F)] (D) 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;
   (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. 2817                             5
 
 the American College of Obstetricians and Gynecologists and the American
 Society for Reproductive Medicine;
   [(iii)]  (II)  The identification of the required training, experience
 and other standards for health  care  providers  for  the  provision  of
 procedures 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)]  (III)  The  determination of appropriate medical candidates by
 the treating physician in accordance with the standards  and  guidelines
 established  and  adopted  by  the American College of Obstetricians and
 Gynecologists and/or the American Society for Reproductive Medicine.
   § 6. This act shall take effect on  the  first  day  of  January  next
 succeeding  the date on which it shall have become a law and shall apply
 to all policies issued, renewed, altered or modified on  or  after  such
 date.