S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    885
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 8, 2025
                                ___________
 
 Introduced  by  M.  of  A.  PAULIN,  BURDICK,  DINOWITZ, GONZALEZ-ROJAS,
   SEAWRIGHT, SIMONE, SIMON, ROSENTHAL, HEVESI, LUNSFORD -- read once and
   referred to the Committee on Insurance
 
 AN ACT to amend the insurance law, in  relation  to  the  definition  of
   infertility and health insurance coverage for in-vitro fertilization
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act shall be known and may be cited as "The Equity  in
 Fertility Treatment Act".
   §  2.  Items  (v)  and  (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, are amended to
 read as follows:
   (v)(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 (A) 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; (B) A PERSON'S
 INABILITY TO REPRODUCE EITHER AS A SINGLE INDIVIDUAL OR WITH THEIR PART-
 NER WITHOUT MEDICAL INTERVENTION;  OR  (C)  A  LICENSED  PHYSICIAN'S  OR
 OSTEOPATHIC  PHYSICIAN'S  FINDINGS BASED ON A PATIENT'S MEDICAL, SEXUAL,
 OR REPRODUCTIVE HISTORY, AGE, PHYSICAL FINDINGS, OR DIAGNOSTIC  TESTING.
 Earlier  evaluation  and treatment may be warranted based on an individ-
 ual's medical, SEXUAL, OR REPRODUCTIVE history [or], AGE, physical find-
 ings, OR DIAGNOSTIC TESTING.
   (II) For purposes of this paragraph, "iatrogenic infertility" means an
 impairment of fertility by surgery,  radiation,  chemotherapy  or  other
 medical treatment affecting reproductive organs or processes.
   (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]
              

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03493-01-5
 A. 885                              2
 
 COMPLETED 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, IN  ACCORDANCE  WITH
 THE  GUIDELINES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE, USING
 SINGLE EMBRYO TRANSFER (SET) WHEN RECOMMENDED AND MEDICALLY  APPROPRIATE
 FOR THE TREATMENT OF INFERTILITY. Coverage (I) SHALL NOT BE DENIED BASED
 ON  A  COVERED INDIVIDUAL'S PARTICIPATION IN FERTILITY SERVICES PROVIDED
 BY OR TO A THIRD PARTY, AND (II) 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  stimulation   for   oocyte
 retrieval  with  the intent of undergoing in-vitro fertilization using a
 fresh embryo transfer; or medications are administered  for  endometrial
 preparation with the intent of undergoing in-vitro fertilization using a
 frozen embryo transfer.]
   §  3.  Subparagraphs  (E)  and (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, are amended to read as follows:
   (E)(i)  For  the  purposes  of  this subsection, "infertility" means a
 disease or condition  characterized  by  the  incapacity  to  impregnate
 another person or to conceive, defined by (A) 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;  (B)  A  PERSON'S
 INABILITY TO REPRODUCE EITHER AS A SINGLE INDIVIDUAL OR WITH THEIR PART-
 NER  WITHOUT  MEDICAL  INTERVENTION;  OR  (C)  A LICENSED PHYSICIAN'S OR
 OSTEOPATHIC PHYSICIAN'S FINDINGS BASED ON A PATIENT'S  MEDICAL,  SEXUAL,
 OR  REPRODUCTIVE HISTORY, AGE, PHYSICAL FINDINGS, OR DIAGNOSTIC TESTING.
 Earlier evaluation and treatment may be warranted based on  an  individ-
 ual's medical history or physical findings.
   (ii)  For  purposes of this subsection, "iatrogenic infertility" means
 an impairment of fertility by surgery, radiation, chemotherapy or  other
 medical treatment affecting reproductive organs or processes.
   (G) Every large group contract that provides medical, major medical or
 similar  comprehensive-type  coverage  shall  provide coverage for three
 [cycles of] COMPLETED 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, IN ACCORD-
 ANCE WITH THE GUIDELINES OF THE AMERICAN SOCIETY FOR REPRODUCTIVE  MEDI-
 CINE,  USING SINGLE EMBRYO TRANSFER (SET) WHEN RECOMMENDED AND MEDICALLY
 APPROPRIATE FOR THE TREATMENT OF INFERTILITY.  Coverage (I) SHALL NOT BE
 DENIED BASED  ON  A  COVERED  INDIVIDUAL'S  PARTICIPATION  IN  FERTILITY
 SERVICES  PROVIDED  BY  OR  TO A THIRD PARTY, AND (II) 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  contract.  [For
 purposes of this subparagraph, a "cycle" is defined as either all treat-
 ment  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 transfer; or medications are
 administered  for  endometrial preparation with the intent of undergoing
 in-vitro fertilization using a frozen embryo transfer.]
   § 4. This act shall take effect immediately.