NY State Senate Bill 2025-S5545

Senate Bill S5545

2025-2026 Legislative Session

Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility

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Current 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
Feb 24, 2025	referred to insurance

co-Sponsors

2025-S5545 (ACTIVE) - Details

See Assembly Version of this Bill:: A885
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S6118, A6177

2025-S5545 (ACTIVE) - Summary

Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.

2025-S5545 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5545

SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:

An act to amend the insurance law, in relation to the definition of
infertility and health insurance coverage for in-vitro fertilization

 
PURPOSE:

To ensure that all those wish to become parents through in-vitro ferti-
lization (IVF) may have the coverage to do so by requiring insurance
coverage for donor cycle.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 sets out the title of this act.

Section 2 amends section 3221 of the insurance law to expand IVF cover-
age to include donor cycles.

Section 3 amends section 4303 of the insurance law to expand IVF cover-

age to include donor cycles.

Section 4 provides the effective date.

 
JUSTIFICATION:

The 2019 enacted budget established a requirement for insurance compa-
nies to cover three IVF cycles. The intent was to make the language
non-discriminatory for the LGBTQ+ community. However, key groups were
inadvertently excluded. While the law affords coverage to couples where
one of the partners is using IVF, coverage is unavailable to gay men, as
donor cycles, a key element necessary to obtain an egg, are not covered.
Coverage is therefore also not available for lesbian couples where
neither partner will undergo IVF.

The original 2019 legislation intended to cover three completed cycles
of IVF where one complete cycle begins with either hormone treatment and
retrieval, depending on the needs of the parents, and ends with trans-
fer. However, currently, insurance companies have interpreted a complete
cycle of IVF to only be one phase of the process. For example, insurers
have interpreted retrieval as one completed cycle and transfer as anoth-
er completed cycle. As a result, some couples are left to pay out of
pocket, even when transferring embryos from a covered cycle, or when
additional cycles of IVF are needed, and others must stop their IVF
journey entirely as they cannot afford the care. Further, when transfers
are not properly covered, it serves as an incentive to transfer too many
embryos in one transfer, which is risky and leads to bad medical
outcomes for all involved.

This legislation will ensure that the 2019 law is implemented as
intended by requiring coverage of donor cycles and explicitly stating
that coverage will be provided for three full rounds of IVF, each
including a completed oocyte retrieval and the process of in-vitro
fertilization with unlimited embryo transfers from the covered
retrieval. This legislation will ensure that those who wish to become
parents through IVF, and have the insurance coverage afforded by the
2019 legislation, are able to do so.
 
LEGISLATIVE HISTORY:


S.6118 of 2023-2024 (Hoylman-Sigal): Died in Rules

A.6177 of 2023-2024 (Paulin): Died in Insurance

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.

2025-S5545 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5545
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 24, 2025
                                ___________
 
 Introduced  by  Sens.  HOYLMAN-SIGAL,  COONEY  -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Insur-
   ance
 
 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]
 COMPLETED  OOCYTE  RETRIEVALS  AND  in-vitro  fertilization [used in the

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03493-01-5
 S. 5545                             2

 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.

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Senate Bill S5545

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Sponsored By

Brad Hoylman-Sigal