S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9535
 
                             I N  S E N A T E
 
                               May 16, 2024
                                ___________
 
 Introduced  by Sen. SCARCELLA-SPANTON -- read twice and ordered printed,
   and when printed to be committed to the Committee on Women's Issues
 
 AN ACT to amend the insurance law, in relation  to  expanding  insurance
   coverage of in vitro fertilization, including individual health insur-
   ance policy coverage
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Item (vii) of subparagraph (C) of paragraph 6 of subsection
 (k) of section 3221 of the insurance law, as amended  by  section  1  of
 part L of chapter 57 of the laws of 2019, is amended to read as follows:
   (vii)  Every  large  group  policy delivered or issued for delivery in
 this state that provides medical, major medical  or  similar  comprehen-
 sive-type coverage shall provide coverage for three [cycles of in-vitro]
 COMPLETE OOCYTE RETRIEVALS AND IN VITRO fertilization used in the treat-
 ment of infertility WITH UNLIMITED EMBRYO TRANSFERS FROM FRESH OR FROZEN
 OOCYTES  OR EMBRYOS FROM A COVERED RETRIEVAL. Coverage may be subject to
 annual deductibles and coinsurance,  including  copayments,  as  may  be
 deemed  appropriate  by  the  superintendent  and as are consistent with
 those established  for  other  benefits  within  a  given  policy.  [For
 purposes of this item, a "cycle" is defined as either all treatment that
 starts when: preparatory medications are administered for ovarian stimu-
 lation  for  oocyte  retrieval  with  the  intent of undergoing in-vitro
 fertilization using a fresh embryo transfer; or medications are adminis-
 tered for endometrial preparation with the intent of undergoing in-vitro
 fertilization using a frozen embryo transfer.]
   § 2. Subparagraph (G) of paragraph 3 of subsection (s) of section 4303
 of the insurance law, as amended by section 2 of part L of chapter 57 of
 the laws of 2019, is amended to read as follows:
   (G) Every large group contract that provides medical, major medical or
 similar comprehensive-type coverage shall  provide  coverage  for  three
 [cycles  of in-vitro] COMPLETE OOCYTE RETRIEVALS AND IN VITRO fertiliza-
 tion used in the treatment of infertility WITH UNLIMITED  EMBRYO  TRANS-
 FERS  FROM  FRESH OR FROZEN OOCYTES OR EMBRYOS FROM A COVERED RETRIEVAL.
 Coverage may be subject to annual deductibles and coinsurance, including
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15362-01-4
 S. 9535                             2
 
 copayments, as may be deemed appropriate by the  superintendent  and  as
 are  consistent with those established for other benefits within a given
 contract. [For purposes of this subparagraph, a "cycle"  is  defined  as
 either  all  treatment  that  starts  when:  preparatory medications are
 administered for ovarian  stimulation  for  oocyte  retrieval  with  the
 intent  of undergoing in-vitro fertilization using a fresh embryo trans-
 fer; or medications are administered for  endometrial  preparation  with
 the  intent  of  undergoing in-vitro fertilization using a frozen embryo
 transfer.]
   § 3. Paragraph 13 of subsection (i) of section 3216 of  the  insurance
 law, as added by chapter 897 of the laws of 1990 and renumbered by chap-
 ter  131  of the laws of 1992 and subparagraph (C) as added by section 3
 of part L of chapter 57 of the laws of  2019,  is  amended  to  read  as
 follows:
   (13)  (A) Every policy which provides coverage for hospital care shall
 not exclude coverage for hospital care for diagnosis  and  treatment  of
 correctable  medical  conditions  otherwise covered by the policy solely
 because the  medical  condition  results  in  infertility[.];  PROVIDED,
 HOWEVER THAT:
   (I)  SUBJECT  TO THE PROVISIONS OF SUBPARAGRAPH (C) OF THIS PARAGRAPH,
 IN NO CASE SHALL SUCH COVERAGE EXCLUDE SURGICAL  OR  MEDICAL  PROCEDURES
 PROVIDED AS PART OF SUCH HOSPITAL CARE WHICH WOULD CORRECT MALFORMATION,
 DISEASE OR DYSFUNCTION RESULTING IN INFERTILITY; AND
   (II)  PROVIDED,  FURTHER  HOWEVER,  THAT  SUBJECT TO THE PROVISIONS OF
 SUBPARAGRAPH (C) OF THIS PARAGRAPH,  IN  NO  CASE  SHALL  SUCH  COVERAGE
 EXCLUDE  DIAGNOSTIC TESTS AND PROCEDURES PROVIDED AS PART OF SUCH HOSPI-
 TAL CARE THAT ARE NECESSARY TO DETERMINE INFERTILITY OR THAT ARE  NECES-
 SARY   IN   CONNECTION  WITH  ANY  SURGICAL  OR  MEDICAL  TREATMENTS  OR
 PRESCRIPTION DRUG COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH,  INCLUD-
 ING SUCH DIAGNOSTIC TESTS AND PROCEDURES AS HYSTEROSALPINGOGRAM, HYSTER-
 OSCOPY,  ENDOMETRIAL  BIOPSY, LAPAROSCOPY, SONO-HYSTEROGRAM, POST COITAL
 TESTS, TESTIS BIOPSY, SEMEN ANALYSIS, BLOOD TESTS AND ULTRASOUND; AND
   (III) PROVIDED, FURTHER HOWEVER,  EVERY  SUCH  POLICY  WHICH  PROVIDES
 COVERAGE  FOR  PRESCRIPTION  DRUGS  SHALL INCLUDE, WITHIN SUCH COVERAGE,
 COVERAGE FOR PRESCRIPTION DRUGS APPROVED BY THE FEDERAL  FOOD  AND  DRUG
 ADMINISTRATION  FOR USE IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY IN
 ACCORDANCE WITH SUBPARAGRAPH (C) OF THIS PARAGRAPH.
   (B) Every policy which provides coverage for surgical and medical care
 shall not exclude coverage for surgical and medical care  for  diagnosis
 and treatment of correctable medical conditions otherwise covered by the
 policy  solely  because the medical condition results in infertility[.];
 PROVIDED, HOWEVER THAT:
   (I) SUBJECT TO THE PROVISIONS OF SUBPARAGRAPH (C) OF  THIS  PARAGRAPH,
 IN  NO  CASE  SHALL SUCH COVERAGE EXCLUDE SURGICAL OR MEDICAL PROCEDURES
 WHICH WOULD CORRECT MALFORMATION, DISEASE OR  DYSFUNCTION  RESULTING  IN
 INFERTILITY; AND
   (II)  PROVIDED,  FURTHER  HOWEVER,  THAT  SUBJECT TO THE PROVISIONS OF
 SUBPARAGRAPH (C) OF THIS PARAGRAPH,  IN  NO  CASE  SHALL  SUCH  COVERAGE
 EXCLUDE  DIAGNOSTIC TESTS AND PROCEDURES THAT ARE NECESSARY TO DETERMINE
 INFERTILITY OR THAT ARE NECESSARY IN CONNECTION  WITH  ANY  SURGICAL  OR
 MEDICAL  TREATMENTS  OR  PRESCRIPTION DRUG COVERAGE PROVIDED PURSUANT TO
 THIS PARAGRAPH,  INCLUDING  SUCH  DIAGNOSTIC  TESTS  AND  PROCEDURES  AS
 HYSTEROSALPINGOGRAM,   HYSTEROSCOPY,  ENDOMETRIAL  BIOPSY,  LAPAROSCOPY,
 SONO-HYSTEROGRAM, POST COITAL  TESTS,  TESTIS  BIOPSY,  SEMEN  ANALYSIS,
 BLOOD TESTS AND ULTRASOUND; AND
 S. 9535                             3
 
   (III)  PROVIDED,  FURTHER  HOWEVER,  EVERY  SUCH POLICY WHICH PROVIDES
 COVERAGE FOR PRESCRIPTION DRUGS SHALL  INCLUDE,  WITHIN  SUCH  COVERAGE,
 COVERAGE  FOR  PRESCRIPTION  DRUGS APPROVED BY THE FEDERAL FOOD AND DRUG
 ADMINISTRATION FOR USE IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY  IN
 ACCORDANCE WITH SUBPARAGRAPH (C) OF THIS PARAGRAPH.
   (C)  [Every  policy  that  provides  medical, major medical or similar
 comprehensive-type coverage shall  provide  coverage  for]  COVERAGE  OF
 DIAGNOSTIC  AND TREATMENT PROCEDURES, INCLUDING PRESCRIPTION DRUGS, USED
 IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY AS  REQUIRED  BY  SUBPARA-
 GRAPHS  (A)  AND  (B)  OF THIS PARAGRAPH SHALL BE PROVIDED IN ACCORDANCE
 WITH THE PROVISIONS OF THIS SUBPARAGRAPH.
   (I) 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.
   (II) COVERAGE MAY BE SUBJECT TO CO-PAYMENTS, COINSURANCE  AND  DEDUCT-
 IBLES  AS  MAY  BE  DEEMED  APPROPRIATE BY THE SUPERINTENDENT AND AS ARE
 CONSISTENT WITH THOSE ESTABLISHED FOR  OTHER  BENEFITS  WITHIN  A  GIVEN
 POLICY.
   (III) EXCEPT AS PROVIDED IN ITEMS (VI) AND (VII) OF THIS SUBPARAGRAPH,
 COVERAGE SHALL NOT BE REQUIRED TO INCLUDE THE DIAGNOSIS AND TREATMENT OF
 INFERTILITY  IN  CONNECTION  WITH:  (I)  IN  VITRO FERTILIZATION, GAMETE
 INTRAFALLOPIAN TUBE TRANSFERS OR ZYGOTE INTRAFALLOPIAN  TUBE  TRANSFERS;
 (II)  THE  REVERSAL  OF ELECTIVE STERILIZATIONS; (III) SEX CHANGE PROCE-
 DURES; (IV) CLONING; OR (V) MEDICAL OR SURGICAL SERVICES  OR  PROCEDURES
 THAT  ARE  DEEMED  TO BE EXPERIMENTAL IN ACCORDANCE WITH CLINICAL GUIDE-
 LINES REFERENCED IN ITEM (IV) OF THIS SUBPARAGRAPH.
   (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  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;
   (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
   (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.
   (V)  COVERAGE  SHALL  ALSO  INCLUDE  standard  fertility  preservation
 services  when  a  medical  treatment  may  directly or indirectly cause
 iatrogenic infertility to an insured. Coverage may be subject to  annual
 deductibles  and  coinsurance,  including  copayments,  as may be deemed
 appropriate by the superintendent  and  as  are  consistent  with  those
 established for other benefits within a given policy.
   (VI)  EVERY  POLICY  WHICH  PROVIDES  COVERAGE FOR HOSPITAL CARE SHALL
 PROVIDE COVERAGE FOR THREE  COMPLETE  OOCYTE  RETRIEVALS  AND  IN  VITRO
 FERTILIZATION USED IN THE TREATMENT OF INFERTILITY WITH UNLIMITED EMBRYO
 TRANSFERS  FROM  FRESH  OR  FROZEN  OOCYTES  OR  EMBRYOS  FROM A COVERED
 RETRIEVAL. COVERAGE MAY BE SUBJECT TO  ANNUAL  DEDUCTIBLES  AND  COINSU-
 S. 9535                             4
 
 RANCE,  INCLUDING COPAYMENTS, AS MAY BE DEEMED APPROPRIATE BY THE SUPER-
 INTENDENT AND AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR  OTHER  BENE-
 FITS WITHIN A GIVEN POLICY.
   (VII)  (I)  FOR  THE PURPOSES OF THIS PARAGRAPH, "INFERTILITY" MEANS A
 DISEASE OR CONDITION  CHARACTERIZED  BY  THE  INCAPACITY  TO  IMPREGNATE
 ANOTHER  PERSON  OR  TO  CONCEIVE, DEFINED BY THE FAILURE TO ESTABLISH A
 CLINICAL PREGNANCY AFTER TWELVE MONTHS OF  REGULAR,  UNPROTECTED  SEXUAL
 INTERCOURSE  OR  THERAPEUTIC  DONOR INSEMINATION, OR AFTER SIX MONTHS OF
 REGULAR, UNPROTECTED SEXUAL INTERCOURSE OR THERAPEUTIC  DONOR  INSEMINA-
 TION  FOR A FEMALE THIRTY-FIVE YEARS OF AGE OR OLDER. EARLIER EVALUATION
 AND TREATMENT MAY BE WARRANTED BASED ON AN INDIVIDUAL'S MEDICAL  HISTORY
 OR PHYSICAL FINDINGS.
   [(i)]  (II) For purposes of this [subparagraph] PARAGRAPH, "iatrogenic
 infertility" means an impairment of  fertility  by  surgery,  radiation,
 chemotherapy or other medical treatment affecting reproductive organs or
 processes.
   [(ii)] (VIII) No insurer providing coverage under this paragraph shall
 discriminate  based  on an insured'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.
   (D) EVERY POLICY THAT PROVIDES  COVERAGE  FOR  PRESCRIPTION  FERTILITY
 DRUGS AND REQUIRES OR PERMITS PRESCRIPTION DRUGS TO BE PURCHASED THROUGH
 A  NETWORK  PARTICIPATING  MAIL ORDER OR OTHER NON-RETAIL PHARMACY SHALL
 PROVIDE THE SAME COVERAGE FOR PRESCRIPTION  FERTILITY  DRUGS  WHEN  SUCH
 DRUGS  ARE  PURCHASED FROM A NETWORK PARTICIPATING NON-MAIL ORDER RETAIL
 PHARMACY PROVIDED THAT THE NETWORK PARTICIPATING NON-MAIL  ORDER  RETAIL
 PHARMACY  AGREES  IN ADVANCE THROUGH A CONTRACTUAL NETWORK AGREEMENT, TO
 THE SAME REIMBURSEMENT AMOUNT, AS WELL AS THE SAME APPLICABLE TERMS  AND
 CONDITIONS, THAT THE INSURER HAS ESTABLISHED FOR A NETWORK PARTICIPATING
 MAIL  ORDER OR OTHER NON-RETAIL PHARMACY. IN SUCH CASE, THE POLICY SHALL
 NOT IMPOSE ANY FEE, CO-PAYMENT, COINSURANCE, DEDUCTIBLE OR OTHER  CONDI-
 TION ON ANY COVERED PERSON WHO ELECTS TO PURCHASE PRESCRIPTION FERTILITY
 DRUGS  THROUGH  A  NETWORK  PARTICIPATING NON-MAIL ORDER RETAIL PHARMACY
 THAT IT DOES NOT IMPOSE ON ANY COVERED PERSON WHO PURCHASES PRESCRIPTION
 FERTILITY DRUGS THROUGH A NETWORK  PARTICIPATING  MAIL  ORDER  OR  OTHER
 NON-RETAIL  PHARMACY;  PROVIDED,  HOWEVER,  THAT  THE PROVISIONS OF THIS
 SECTION SHALL NOT SUPERSEDE THE TERMS OF A COLLECTIVE BARGAINING  AGREE-
 MENT  OR APPLY TO A POLICY THAT IS THE RESULT OF A COLLECTIVE BARGAINING
 AGREEMENT BETWEEN AN EMPLOYER AND A  RECOGNIZED  OR  CERTIFIED  EMPLOYEE
 ORGANIZATION.
   §  4.  This  act shall take effect January 1, 2025, and shall apply to
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such date.