NY State Senate Bill 2019-S719

Senate Bill S719

2019-2020 Legislative Session

Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to insurance
Jan 09, 2019	referred to insurance

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2019-S719 (ACTIVE) - Details

See Assembly Version of this Bill:: A2817
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2015-2016: S7219, A10137
2017-2018: S3148, A2646

2019-S719 (ACTIVE) - Summary

Relates to insurance coverage of in vitro fertilization and other fertility preservation treatments.

2019-S719 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S719

SPONSOR: SAVINO
 
TITLE OF BILL:  An act to amend the insurance law, in relation to
insurance coverage of in vitro fertilization and other fertility preser-
vation treatments

 
PURPOSE:

To require health insurance policies to provide coverage for in-vitro
fertilization

 
SUMMARY OF PROVISIONS:

Sections one of the bill amends section 3216 of the Ins. L. to require
that individual policies provide coverage for (1) in-vitro fertilization
used in the treatment of infertility, and (2) fertility preservation
services, regardless of length or quality of life, medical dependency,
disability, or personal characteristics.

Section two of the bill would amend section 3221 of the Ins. L. to

require that group policies provide coverage for (1) in-vitro fertiliza-
tion used in the treatment of infertility, and (2) fertility preserva-
tion services, regardless of length or quality of life, medical depend-
ency, disability, or personal characteristics.

Section three of the bill would amend Section 4303 of the Ins. L. to
require that policies issued by a medical expense indemnity corporation,
hospital service corporation, or health service corporation provide
coverage for (1) in-vitro fertilization used in the treatment of infer-
tility, and (2) fertility preservation services, regardless of length or
quality of life, medical dependency, disability, or personal character-
istics.

Section four of the bill amends subparagraph c of paragraph 6 of
subsection k of section 3221 of the insurance law to repeal discrimina-
tory age restrictions and provisions exempting in-vitro fertilization,
gamete intrafallopian tube transfers or zygote intrafallopian tube
transfers from coverage requirements for group or blanket accident and
health insurance plans.

Section five of the bill amends paragraph 3 of subsection S of section
4303 of the insurance law to apply the same requirements to benefits
provided by a medical expense indemnity corporation, hospital service
corporation, or health service corporation.

Section six of the bill provides the effective date of the bill.

 
EXISTING LAW:

Currently, New York requires coverage of some infertility treatments in
the commercial market place for women between the ages of 21 and 44,
However, current law does not require coverage for in-vitro fertilize-
tion (IVF), or fertility preservation.

 
JUSTIFICATION:

It is estimated that one in eight individuals or couples have trouble
getting pregnant or sustaining pregnancy. While family building options
do exist for people affected by infertility, these options are often
cost-prohibitive, with 671 of individuals or couples reporting spending
at least $10,000. High costs present a major bather to medical treat-
ment; nearly half of all individuals affected by infertility lack insur-
ance coverage necessary for fertility treatment.

The rapid advancement of medical technology in the past 20 years estab-
lished in-vitro fertilization as the safest and most effective form of
fertility treatment. Compared to treatments presently covered under New
York state law, such as ovulation induction or ovulation enhancement,
in-vitro fertilization results in fewer pregnancy complications and
high-risk births. Several states, including Massachusetts, Rhode Island,
New Jersey, Maryland, Illinois, Arkansas, Hawaii, and Connecticut, have
already enacted laws requiring insurers to cover in-vitro fertilization.
These states experience lower rates of multiple births and associated
neo-natal and pediatric care costs. This legislation has the potential
to save New York millions of dollars in long-term health care costs,
since patients would no longer be forced to rely on higher risk medical
procedures.

Under current law, New York requires insurers to provide coverage for
some diagnostic and treatment procedures for infertility. However, these
requirements do not extend to in-vitro fertilization. This bill would
update the existing law to reflect advances in modern medical technolo-
gy, requiring coverage for in-vitro fertilization to expand access to
this procedure and enable patients and their physicians to choose the
best course of treatment for infertility. It would also provide a clear
definition of infertility and ensure that cancer patients whose ability
to conceive has been compromised by chemotherapy, radiation, surgery, or
other medical procedures have fair access to fertility preservation
methods. Lastly, this bill includes anti-discrimination protections for
patients eligible for in-vitro fertilization, as required by the Afford-
able Care Act.

 
LEGISLATIVE HISTORY:

2018 Session- S.3148 - referred to Insurance, same as bill passed Assem-
bly
2017 Session- S.3148 - referred to Insurance, same as bill passed Assem-
bly
2016 Session- S.7219 referred to Insurance; same as bill reported from
Assembly Insurance and Codes, died in Rules.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act would 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.

2019-S719 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    719
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  Sens.  SAVINO, BIAGGI -- 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 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-
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD01402-02-9

 S. 719                              2
 
 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.
   (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.

 S. 719                              3
 
   (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
 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

 S. 719                              4
 
 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
 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

 S. 719                              5
 
 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.

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