SB 52- AS AMENDED BY THE SENATE
5/6/99 1066s
5/18/99 1275s
1999 SESSION
SENATE BILL 52
AN ACT requiring insurance coverage for infertility treatments.
SPONSORS: Sen. Cohen, Dist 24; Rep. M. Fuller Clark, Rock 36
This bill requires insurance coverage for infertility diagnosis and treatment. Under this bill, insurance companies may charge a higher co-payment if the services exceed $30,000.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
5/6/99 1066s
5/18/99 1275s
99-0252
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord One Thousand Nine Hundred and Ninety-Nine
AN ACT requiring insurance coverage for infertility treatments.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 415 by inserting after section 6-f the following new section:
415:6-g Coverage for Infertility Treatments.
I. Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. For purposes of this section "infertility" means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:
(a) Intrauterine insemination.
(b) In vitro fertilization (IVF).
(c) Frozen embryo transfer.
(d) Gamete intrafallopian transfer (GIFT).
(e) Zygot intrafallopian transfer (ZIFT).
(f) Intracytoplasmic sperm injection (ICSI).
(g) Seven completed egg retrievals per lifetime.
II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:
(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.
(b) The patient has not reached the maximum number of allowed egg retrievals.
III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided, except that if such services exceed $30,000 then such coinsurance may be adjusted not to exceed 50 percent of the reasonable and customary charge for the services provided.
(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.
(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.
(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).
2 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 415 by inserting after section 18-h the following new section:
415:18-i Coverage for Infertility Treatments.
I. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. For purposes of this section "infertility" means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:
(a) Intrauterine insemination.
(b) In vitro fertilization (IVF).
(c) Frozen embryo transfer.
(d) Gamete intrafallopian transfer (GIFT).
(e) Zygote intrafallopian transfer (ZIFT).
(f) Intracytoplasmic sperm injection (ICSI).
(g) Seven completed egg retrievals per lifetime.
II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:
(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.
(b) The patient has not reached the maximum number of allowed egg retrievals.
III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided, except that if such services exceed $30,000 then such coinsurance may be adjusted not to exceed 50 percent of the reasonable and customary charge for the services provided.
(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.
(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.
(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).
3 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 420-A by inserting after section 17-b the following new section:
420-A:17-c Coverage for Infertility Treatments. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual, group, or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. For purposes of this section "infertility" means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:
(a) Intrauterine insemination.
(b) In vitro fertilization (IVF).
(c) Frozen embryo transfer.
(d) Gamete intrafallopian transfer (GIFT).
(e) Zygote intrafallopian transfer (ZIFT).
(f) Intracytoplasmic sperm injection (ICSI).
(g) Seven completed egg retrievals per lifetime.
II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:
(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.
(b) The patient has not reached the maximum number of allowed egg retrievals.
III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided, except that if such services exceed $30,000 then such coinsurance may be adjusted not to exceed 50 percent of the reasonable and customary charge for the services provided.
(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.
(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.
(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).
4 New Section; Coverage for Infertility Treatments. Amend RSA 420-B by inserting after section 8-g the following new section:
420-B:8-gg Coverage for Infertility Diagnosis and Treatment. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual, group, or blanket health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. For purposes of this section "infertility" means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:
(a) Intrauterine insemination.
(b) In vitro fertilization (IVF).
(c) Frozen embryo transfer.
(d) Gamete intrafallopian transfer (GIFT).
(e) Zygote intrafallopian transfer (ZIFT).
(f) Intracytoplasmic sperm injection (ICSI).
(g) Seven completed egg retrievals per lifetime.
II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:
(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.
(b) The patient has not reached the maximum number of allowed egg retrievals.
III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided, except that if such services exceed $30,000 then such coinsurance may be adjusted not to exceed 50 percent of the reasonable and customary charge for the services provided.
(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.
(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.
(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).
5 Effective Date. This act shall take effect 60 days after its passage.