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Senate
File
130
-
Introduced
SENATE
FILE
130
BY
PETERSEN
,
BISIGNANO
,
BLAKE
,
WINCKLER
,
CELSI
,
DONAHUE
,
DOTZLER
,
TOWNSEND
,
WAHLS
,
BENNETT
,
and
WEINER
A
BILL
FOR
An
Act
relating
to
health
insurance
coverage
for
infertility.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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Section
1.
NEW
SECTION
.
514C.37
Infertility
——
coverage.
1
1.
As
used
in
this
section,
unless
the
context
otherwise
2
requires:
3
a.
“ASRM”
means
the
American
society
for
reproductive
4
medicine
or
its
successor
organization.
5
b.
“Covered
person”
means
a
policyholder,
subscriber,
or
6
other
person
participating
in
a
policy,
contract,
or
plan
that
7
provides
for
third-party
payment
or
prepayment
of
health
or
8
medical
expenses.
9
c.
“Diagnosis
of
and
treatment
for
infertility”
means
10
the
procedures
and
medications
recommended
by
a
health
care
11
professional
that
are
consistent
with
established,
published,
12
or
approved
medical
practices
or
professional
guidelines
from
13
the
American
college
of
obstetricians
and
gynecologists
or
its
14
successor
organization,
or
ASRM,
for
diagnosing
and
treating
15
infertility.
16
d.
(1)
“Failure
to
impregnate
or
conceive”
means
any
of
the
17
following:
18
(a)
For
a
woman
under
the
age
of
thirty-five,
the
failure
19
to
establish
a
clinical
pregnancy
after
twelve
months
of
20
regular,
unprotected
sexual
intercourse
or
therapeutic
donor
21
insemination.
22
(b)
For
a
woman
thirty-five
years
of
age
or
older,
the
23
failure
to
establish
a
clinical
pregnancy
after
six
months
of
24
regular,
unprotected
sexual
intercourse
or
therapeutic
donor
25
insemination.
26
(2)
Conception
resulting
in
a
miscarriage
does
not
restart
27
the
twelve-month
or
six-month
time
period
required
to
qualify
28
as
having
infertility.
29
e.
“Health
care
professional”
means
the
same
as
defined
in
30
section
514J.102.
31
f.
“Infertility”
means
a
disease
or
condition
characterized
32
by
any
of
the
following:
33
(1)
The
failure
to
impregnate
or
conceive.
34
(2)
A
person’s
inability
to
reproduce
either
as
an
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individual
or
with
the
person’s
partner.
1
(3)
A
health
care
professional’s
diagnosis
based
on
a
2
covered
person’s
medical,
sexual,
and
reproductive
history,
3
age,
physical
findings,
or
diagnostic
testing.
4
g.
“Standard
fertility
preservation
services”
means
5
procedures
and
services
consistent
with
established
medical
6
practices
or
professional
guidelines
published
by
ASRM
or
7
the
American
society
of
clinical
oncology
or
its
successor
8
organization
for
a
person
who
has
a
medical
condition
or
is
9
expected
to
undergo
medication
therapy,
surgery,
radiation,
10
chemotherapy,
or
other
medical
treatment
that
is
recognized
11
by
health
care
professionals
to
cause
a
risk
of
fertility
12
impairment.
13
2.
a.
Notwithstanding
the
uniformity
of
treatment
14
requirements
of
section
514C.6,
a
policy,
contract,
or
plan
15
providing
for
third-party
payment
or
prepayment
of
health
or
16
medical
expenses
shall
provide
coverage
for
a
covered
person
17
for
the
diagnosis
of
and
treatment
for
infertility,
and
18
standard
fertility
preservation
services.
19
b.
The
coverage
required
by
this
subsection
shall
include
20
up
to
three
completed
oocyte
retrievals
with
unlimited
embryo
21
transfers
in
accordance
with
the
guidelines
of
the
ASRM,
22
using
single
embryo
transfer
if
recommended
and
medically
23
appropriate.
24
c.
The
coverage
required
under
this
subsection
for
fertility
25
medications
shall
not
be
less
favorable
than
coverage
offered
26
for
any
other
prescription
medications
under
the
policy,
27
contract,
or
plan.
28
d.
Except
as
otherwise
provided
in
this
section,
29
deductibles,
copayments,
coinsurance,
benefit
maximums,
30
waiting
periods,
or
other
limitations
on
coverage
for
a
covered
31
person
for
the
diagnosis
of
and
treatment
for
infertility,
32
and
standard
fertility
preservation
services,
shall
not
be
33
less
favorable
than
the
deductibles,
copayments,
coinsurance,
34
benefit
maximums,
waiting
periods,
or
other
limitations
imposed
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on
any
other
benefit
for
services
covered
under
the
policy,
1
contract,
or
plan.
2
3.
A
religious
employer
may
request,
and
a
policy,
contract,
3
or
plan
providing
for
third-party
payment
or
prepayment
of
4
health
or
medical
expenses
shall
grant,
an
exclusion
from
5
the
coverage
required
under
this
section
if
the
required
6
coverage
conflicts
with
the
religious
employer’s
bona
fide
7
religious
beliefs
and
practices.
A
religious
employer
granted
8
an
exclusion
under
this
subsection
shall
provide
its
employees
9
timely
notice
of
the
exclusion
from
the
policy,
contract,
10
or
plan
providing
for
third-party
payment
or
prepayment
of
11
health
or
medical
expenses
the
religious
employer
offers
its
12
employees.
13
4.
a.
This
section
applies
to
the
following
classes
of
14
third-party
payment
provider
contracts,
policies,
or
plans
15
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
16
state
on
or
after
July
1,
2025:
17
(1)
Individual
or
group
accident
and
sickness
insurance
18
providing
coverage
on
an
expense-incurred
basis.
19
(2)
An
individual
or
group
hospital
or
medical
service
20
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
21
(3)
An
individual
or
group
health
maintenance
organization
22
contract
regulated
under
chapter
514B.
23
(4)
A
plan
established
for
public
employees
pursuant
to
24
chapter
509A.
25
b.
This
section
shall
not
apply
to
accident-only,
specified
26
disease,
short-term
hospital
or
medical,
hospital
confinement
27
indemnity,
credit,
dental,
vision,
Medicare
supplement,
28
long-term
care,
basic
hospital
and
medical-surgical
expense
29
coverage
as
defined
by
the
commissioner
of
insurance,
30
disability
income
insurance
coverage,
coverage
issued
as
a
31
supplement
to
liability
insurance,
workers’
compensation
or
32
similar
insurance,
or
automobile
medical
payment
insurance.
33
5.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
34
chapter
17A
to
administer
this
section.
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EXPLANATION
1
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
2
the
explanation’s
substance
by
the
members
of
the
general
assembly.
3
This
bill
relates
to
health
insurance
coverage
for
the
4
diagnosis
of
and
treatment
for
infertility,
and
standard
5
fertility
preservation
services
(preservation
services).
6
The
bill
requires
a
policy,
contract,
or
plan
(plan)
7
providing
for
third-party
payment
or
prepayment
of
health
or
8
medical
expenses
to
provide
coverage
for
the
diagnosis
of
and
9
treatment
for
infertility,
and
for
preservation
services.
10
“Diagnosis
of
and
treatment
for
infertility”,
“infertility”,
11
and
“standard
fertility
preservation
services”
are
defined
in
12
the
bill.
Required
coverage
includes
up
to
three
completed
13
oocyte
retrievals
with
unlimited
embryo
transfers,
using
single
14
embryo
transfer
if
recommended
and
medically
appropriate.
15
Coverage
of
fertility
medications
shall
not
be
less
16
favorable
than
coverage
for
any
other
prescription
medications
17
under
the
plan.
Deductibles,
copayments,
coinsurance,
benefit
18
maximums,
waiting
periods,
or
other
limitations
on
coverage
for
19
the
diagnosis
of
and
treatment
for
infertility
and
preservation
20
services
shall
not
be
any
less
favorable
than
those
imposed
21
on
benefits
for
services
covered
under
the
plan
that
are
not
22
related
to
infertility.
23
The
bill
provides
an
exception
for
a
religious
employer
to
24
request
an
exclusion
from
the
required
coverage
and
requires
25
the
religious
employer
to
provide
notice
to
employees
of
the
26
exclusion.
27
The
bill
applies
to
third-party
payment
provider
contracts,
28
policies,
or
plans
delivered,
issued
for
delivery,
continued,
29
or
renewed
in
this
state
on
or
after
July
1,
2025,
by
the
30
third-party
payment
providers
enumerated
in
the
bill.
The
bill
31
specifies
the
types
of
specialized
health-related
insurance
not
32
subject
to
the
bill.
33
The
commissioner
of
insurance
may
adopt
rules
to
administer
34
the
bill.
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