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S1770
SENATE, No. 1770
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Senator TROY SINGLETON
District 7 (Burlington)
Senator RAJ MUKHERJI
District 32 (Hudson)
SYNOPSIS
���� Requires health insurance coverage of preimplantation
genetic testing with in vitro fertilization under certain conditions.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning
health insurance coverage of
preimplantation genetic testing and in vitro fertilization and amending various
parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Section 1 of P.L.2001,
c.236 (C.17:48-6x) is amended to read as follows:
���� 1.��� a.� A hospital service
corporation contract which provides hospital or medical expense benefits for
groups with more than 50 persons, which includes pregnancy-related benefits,
shall not be delivered, issued, executed or renewed in this State, or approved
for issuance or renewal in this State by the Commissioner of Banking and
Insurance on or after the effective date of this act unless the contract
provides coverage for persons covered under the contract for medically
necessary expenses incurred in the diagnosis and treatment of infertility
,
as provided pursuant to this section
, and for preimplantation genetic
testing, including in vitro fertilization, where the covered persons are not
infertile, for the purpose of preventing certain serious genetic conditions
from being passed on to offspring
.� The hospital service corporation
contract shall provide coverage which includes, but is not limited to, the
following services related to infertility: diagnosis and diagnostic tests;
medications; surgery; in vitro fertilization; embryo transfer; artificial
insemination; gamete intra fallopian transfer; zygote intra fallopian transfer;
intracytoplasmic sperm injection; and four completed egg retrievals per
lifetime of the covered person.� The hospital service corporation may provide
that coverage for in vitro fertilization, gamete intra fallopian transfer and
zygote intra fallopian transfer shall be limited to a covered person who:� a.
has used all reasonable, less expensive and medically appropriate treatments
and is still unable to become pregnant or carry a pregnancy; b. has not reached
the limit of four completed egg retrievals; and c. is 45 years of age or
younger.�
The hospital service corporation may also provide that coverage
for preimplantation genetic testing
with in vitro
fertilization
be limited to covered persons where:
����
(1)�� both
partners are known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
���� (5) the genetic condition,
if passed on to the covered persons� offspring, would result in significant
health problems or severe disability.
����
b.
���
[
For purposes
of
]
As
used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or that the patient has met one of the following
conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2)�� A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the contract, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists.� The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
contract.� Infertility resulting from voluntary sterilization procedures shall
be excluded under the contract for the coverage required by this section.
����
[
b
]
d
.� A religious employer
may request, and a hospital service corporation shall grant, an exclusion under
the contract for the coverage required by this section for in vitro
fertilization, embryo transfer, artificial insemination, zygote intra fallopian
transfer and intracytoplasmic sperm injection, if the required coverage is
contrary to the religious employer's bona fide religious tenets.� The hospital
service corporation that issues a contract containing such an exclusion shall
provide written notice thereof to each prospective subscriber or subscriber,
which shall appear in not less than 10 point type, in the contract, application
and sales brochure.� For the purposes of this subsection, "religious
employer" means an employer that is a church, convention or association of
churches or any group or entity that is operated, supervised or controlled by
or in connection with a church or a convention or association of churches as
defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization
under 26 U.S.C. s.501(c)(3).
����
[
c
]
e
. This section shall
apply to those hospital service corporation contracts in which the hospital
service corporation has reserved the right to change the premium.
����
[
d
]
f
.� The provisions of
this section shall not apply to a hospital service corporation contract which,
pursuant to a contract between the hospital service corporation and the
Department of Human Services, provides benefits to persons who are eligible for
medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare
Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any
other program administered by the Division of Medical Assistance and Health
Services in the Department of Human Services.
(cf: P.L.2017, c.48, s.1)
���� 2.��� Section 2 of P.L.2001,
c.236 (C.17:48A-7w) is amended to read as follows:
���� 2.��� a.� A medical service
corporation contract which provides hospital or medical expense benefits for
groups with more than 50 persons, which includes pregnancy-related benefits,
shall not be delivered, issued, executed or renewed in this State, or approved
for issuance or renewal in this State by the Commissioner of Banking and
Insurance on or after the effective date of this act unless the contract
provides coverage for persons covered under the contract for medically
necessary expenses incurred in the diagnosis and treatment of infertility
,
as provided pursuant to this section
, and for preimplantation genetic
testing, including in vitro fertilization, where the covered persons are not
infertile, for the purpose of preventing certain serious genetic conditions
from being passed on to offspring
.� The medical service corporation
contract shall provide coverage which includes, but is not limited to, the
following services related to infertility: diagnosis and diagnostic tests;
medications; surgery; in vitro fertilization; embryo transfer; artificial
insemination; gamete intra fallopian transfer; zygote intra fallopian transfer;
intracytoplasmic sperm injection; and four completed egg retrievals per
lifetime of the covered person.� The medical service corporation may provide
that coverage for in vitro fertilization, gamete intra fallopian transfer and
zygote intra fallopian transfer shall be limited to a covered person who:� a.
has used all reasonable, less expensive and medically appropriate treatments
and is still unable to become pregnant or carry a pregnancy; b. has not reached
the limit of four completed egg retrievals; and c. is 45 years of age or
younger.
The medical service corporation may also provide that coverage for
preimplantation genetic testing with in vitro fertilization be limited to
covered persons where:
����
(1)�� both
partners are known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
(5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability.
����
b.
���
[
For
purposes of
]
As used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or that the patient has met one of the following
conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2)�� A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.�
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the contract, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists.� The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
contract.� Infertility resulting from voluntary sterilization procedures shall
be excluded under the contract for the coverage required by this section.
����
[
b
]
d
.� A religious employer
may request, and a medical service corporation shall grant, an exclusion under
the contract for the coverage required by this section for in vitro
fertilization, embryo transfer, artificial insemination, zygote intra fallopian
transfer and intracytoplasmic sperm injection, if the required coverage is
contrary to the religious employer's bona fide religious tenets.� The medical
service corporation that issues a contract containing such an exclusion shall
provide written notice thereof to each prospective subscriber or subscriber,
which shall appear in not less than ten point type, in the contract,
application and sales brochure.� For the purposes of this subsection,
"religious employer" means an employer that is a church, convention
or association of churches or any group or entity that is operated, supervised
or controlled by or in connection with a church or a convention or association
of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a
tax-exempt organization under 26 U.S.C. s.501(c)(3).
����
[
c
]
e
. This section shall
apply to those medical service corporation contracts in which the medical
service corporation has reserved the right to change the premium.
����
[
d
]
f
.� The provisions of
this section shall not apply to a medical service corporation contract which,
pursuant to a contract between the medical service corporation and the
Department of Human Services, provides benefits to persons who are eligible for
medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare
Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any
other program administered by the Division of Medical Assistance and Health
Services in the Department of Human Services.
(cf: P.L.2017, c.48, s.2)
���� 3.��� Section 3 of P.L.2001,
c.236 (C.17:48E-35.22) is amended to read as follows:
���� 3.��� a.� A health service
corporation contract which provides hospital or medical expense benefits for
groups with more than 50 persons, which includes pregnancy-related benefits,
shall not be delivered, issued, executed or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Banking and Insurance
on or after the effective date of this act unless the contract provides
coverage for persons covered under the contract for medically necessary
expenses incurred in the diagnosis and treatment of infertility
,
as
provided pursuant to this section
, and for preimplantation genetic testing,
including in vitro fertilization, where the covered persons are not infertile,
for the purpose of preventing certain serious genetic conditions from being
passed on to offspring
.� The health service corporation contract shall
provide coverage which includes, but is not limited to, the following services
related to infertility: diagnosis and diagnostic tests; medications; surgery;
in vitro fertilization; embryo transfer; artificial insemination; gamete intra
fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm
injection; and four completed egg retrievals per lifetime of the covered
person.� The health service corporation may provide that coverage for in vitro
fertilization, gamete intra fallopian transfer and zygote intra fallopian
transfer shall be limited to a covered person who: a. has used all reasonable,
less expensive and medically appropriate treatments and is still unable to
become pregnant or carry a pregnancy; b. has not reached the limit of four
completed egg retrievals; and c. is 45 years of age or younger.�
The health
service corporation may also provide that coverage for preimplantation genetic
testing
with in vitro fertilization
be limited to
covered persons where:
����
(1)�� both partners are
known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
(5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability.
����
b.
���
[
For
purposes of
]
As used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or that the patient has met one of the following
conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2)�� A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.�
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the contract, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists.� The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
contract. Infertility resulting from voluntary sterilization procedures shall
be excluded under the contract for the coverage required by this section.
����
[
b
]
d
.� A religious employer
may request, and a health service corporation shall grant, an exclusion under
the contract for the coverage required by this section for in vitro
fertilization, embryo transfer, artificial insemination, zygote intra fallopian
transfer and intracytoplasmic sperm injection, if the required coverage is
contrary to the religious employer's bona fide religious tenets.� The health
service corporation that issues a contract containing such an exclusion shall
provide written notice thereof to each prospective subscriber or subscriber,
which shall appear in not less than ten point type, in the contract,
application and sales brochure.� For the purposes of this subsection,
"religious employer" means an employer that is a church, convention
or association of churches or any group or entity that is operated, supervised
or controlled by or in connection with a church or a convention or association
of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a
tax-exempt organization under 26 U.S.C. s.501(c)(3).
����
[
c
]
e
.� This section shall
apply to those health service corporation contracts in which the health service
corporation has reserved the right to change the premium.
����
[
d
]
f
.� The provisions of
this section shall not apply to a health service corporation contract which,
pursuant to a contract between the health service corporation and the
Department of Human Services, provides benefits to persons who are eligible for
medical assistance under P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare
Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any
other program administered by the Division of Medical Assistance and Health
Services in the Department of Human Services.
(cf: P.L.2017, c.48, s.3)
���� 4.��� Section 4 of P.L.2001,
c.236 (C.17B:27-46.1x) is amended to read as follows:
���� 4.��� a.� A group health
insurance policy which provides hospital or medical expense benefits for groups
with more than 50 persons, which includes pregnancy-related benefits, shall not
be delivered, issued, executed or renewed in this State, or approved for issuance
or renewal in this State by the Commissioner of Banking and Insurance on or
after the effective date of this act unless the policy provides coverage for
persons covered under the policy for medically necessary expenses incurred in
the diagnosis and treatment of infertility
,
as provided pursuant to this
section
, and for preimplantation genetic testing, including in vitro
fertilization, where the covered persons are not infertile, for the purpose of
preventing certain serious genetic conditions from being passed on to offspring
.�
The policy shall provide coverage which includes, but is not limited to, the
following services related to infertility: diagnosis and diagnostic tests;
medications; surgery; in vitro fertilization; embryo transfer; artificial insemination;
gamete intra fallopian transfer; zygote intra fallopian transfer;
intracytoplasmic sperm injection; and four completed egg retrievals per
lifetime of the covered person.� The insurer may provide that coverage for in
vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian
transfer shall be limited to a covered person who: a. has used all reasonable,
less expensive and medically appropriate treatments and is still unable to
become pregnant or carry a pregnancy; b. has not reached the limit of four
completed egg retrievals; and c. is 45 years of age or younger.�
The insurer
may also provide that coverage for preimplantation genetic testing with in
vitro fertilization be limited to covered persons where:
����
(1)�� both
partners are known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
(5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability.
����
b.
���
[
For purposes
of
]
As
used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or that the patient has met one of the following
conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2) A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3) A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.�
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the policy, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists.� The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
policy. Infertility resulting from voluntary sterilization procedures shall be
excluded under the policy for the coverage required by this section.
����
[
b
]
d
.�������� A religious
employer may request, and an insurer shall grant, an exclusion under the policy
for the coverage required by this section for in vitro fertilization, embryo
transfer, artificial insemination, zygote intra fallopian transfer and
intracytoplasmic sperm injection, if the required coverage is contrary to the
religious employer's bona fide religious tenets.� The insurer that issues a
policy containing such an exclusion shall provide written notice thereof to
each prospective insured or insured, which shall appear in not less than ten
point type, in the policy, application and sales brochure.� For the purposes of
this subsection, "religious employer" means an employer that is a
church, convention or association of churches or any group or entity that is
operated, supervised or controlled by or in connection with a church or a
convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A),
and that qualifies as a tax-exempt organization under
26 U.S.C. s.501(c)(3).
����
[
c
]
e
.� This section shall
apply to those insurance policies in which the insurer has reserved the right
to change the premium.
����
[
d
]
f
.� The provisions of
this section shall not apply to a group health insurance policy which, pursuant
to a contract between the insurer and the Department of Human Services,
provides benefits to persons who are eligible for medical assistance under
P.L.1968, c.413 (C.30:4D-1 et seq.), the NJ FamilyCare Program established
pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), or any other program
administered by the Division of Medical Assistance and Health Services in the
Department of Human Services.
(cf: P.L.2017, c.48, s.4)
���� 5.��� Section 5 of P.L.2001,
c.236 (C.26:2J-4.23) is amended to read as follows:
���� 5.��� a.� No certificate of
authority to establish and operate a health maintenance organization in this
State shall be issued or continued on or after the effective date of this act
unless the health maintenance organization provides health care services, to groups
of more than 50 enrollees, for medically necessary expenses incurred in the
diagnosis and treatment of infertility
,
as provided pursuant to this
section
, and for preimplantation genetic testing
, including in vitro fertilization, where the covered
persons are not infertile, for the purpose of preventing certain serious
genetic conditions from being passed on to offspring
. A health
maintenance organization shall provide enrollee coverage which includes, but is
not limited to, the following services related to infertility: diagnosis and
diagnostic tests; medications; surgery; in vitro fertilization; embryo
transfer; artificial insemination; gamete intra fallopian transfer; zygote
intra fallopian transfer; intracytoplasmic sperm injection; and four completed
egg retrievals per lifetime of the enrollee.� The health maintenance
organization may provide that health care services for in vitro fertilization,
gamete intra fallopian transfer and zygote intra fallopian transfer shall be
limited to a covered person who: a. has used all reasonable, less expensive and
medically appropriate treatments and is still unable to become pregnant or
carry a pregnancy; b. has not reached the limit of four completed egg
retrievals; and c. is 45 years of age or younger.�
The health maintenance
organization may also provide that coverage for preimplantation genetic testing
with in vitro fertilization be limited to covered persons where:
����
(1)�� both partners are
known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
(5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability.
����
b.
���
[
For purposes
of
]
As
used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or that the patient has met one of the following
conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2)�� A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.�
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The health care
services shall be provided to the same extent as for other pregnancy-related
procedures under the contract, except that the services provided for in this
section shall be performed at facilities that conform to standards established
by the American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists.� The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical health care services
under the contract.� Infertility resulting from voluntary sterilization
procedures shall be excluded under the contract for the coverage required by
this section.
����
[
b
]
d
. A religious employer
may request, and a health maintenance organization shall grant, an exclusion
under the contract for the health care services required by this section for in
vitro fertilization, embryo transfer, artificial insemination, zygote intra
fallopian transfer and intracytoplasmic sperm injection, if the required health
care services are contrary to the religious employer's bona fide religious
tenets.� The health maintenance organization that issues a contract containing
such an exclusion shall provide written notice thereof to each prospective
enrollee or enrollee, which shall appear in not less than ten point type, in
the contract, application and sales brochure.� For the purposes of this
subsection, "religious employer" means an employer that is a church,
convention or association of churches or any group or entity that is operated,
supervised or controlled by or in connection with a church or a convention or
association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies
as a tax-exempt organization under 26 U.S.C. s.501(c)(3).
����
[
c
]
e
.� The provisions of
this section shall apply to those contracts for health care services by health
maintenance organizations under which the right to change the schedule of
charges for enrollee coverage is reserved.
����
[
d
]
f
.� The provisions of
this section shall not apply to a contract for health care services by a health
maintenance organization which, pursuant to a contract between the health
maintenance organization and the Department of Human Services, provides benefits
to persons who are eligible for medical assistance under P.L.1968, c.413
(C.30:4D-1 et seq.), the NJ FamilyCare Program established pursuant to
P.L.2005, c.156 (C.30:4J-8 et al.), or any other program administered by the
Division of Medical Assistance and Health Services in the Department of Human
Services.
(cf: P.L.2017, c.48, s.5)
���� 6.��� Section 6 of P.L.2017,
c.48 (C.52:14-17.29v) is amended to read as follows:
���� 6.���
a.
� The State
Health Benefits Commission shall ensure that every contract under the State
Health Benefits Program shall provide coverage for medically necessary expenses
incurred in the diagnosis and treatment of infertility
,
as provided
pursuant to this section
, and for preimplantation genetic testing, including
in vitro fertilization, where the covered persons are not infertile, for the
purpose of preventing certain serious genetic conditions from being passed on
to offspring
. The State Health Benefits Program contract shall provide
coverage which includes, but is not limited to, the following services related
to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro
fertilization; embryo transfer; artificial insemination; gamete intra fallopian
transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection;
and four completed egg retrievals per lifetime of the covered person. The State
Health Benefits Commission may provide that coverage for in vitro
fertilization, gamete intra fallopian transfer and zygote intra fallopian
transfer shall be limited to a covered person who: a. has used all reasonable,
less expensive and medically appropriate treatments and is still unable to
become pregnant or carry a pregnancy; b. has not reached the limit of four
completed egg retrievals; and c. is 45 years of age or younger.�
The State
Health Benefits Commission may also provide that coverage for preimplantation
genetic testing with in vitro fertilization be limited to covered persons where:
����
(1)�� both partners are
known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
����
(5) the genetic condition,
if passed on to the covered persons� offspring, would result in significant
health problems or severe disability.
����
b.
���
[
For purposes
of
]
As
used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or any one of the following conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2)�� A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the contract, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists. The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
contract.� Infertility resulting from voluntary sterilization procedures shall
be excluded under the contract for the coverage required by this section.
(cf: P.L.2017, c.48, s.6)
���� 7.��� Section 7 of P.L.2017,
c.48 (C.52:14-17.46.6g) is amended to read as follows:
���� 7.���
a.
� The School
Employees Health Benefits Commission shall ensure that every contract under the
School Employees Health Benefits Program shall provide coverage for medically
necessary expenses incurred in the diagnosis and treatment of infertility
,
as provided pursuant to this section
, and for preimplantation genetic
testing, including in vitro fertilization, where the covered persons are not
infertile, for the purpose of preventing certain serious genetic conditions
from being passed on to offspring
.� The School Employees Health Benefits
Program contract shall provide coverage which includes, but is not limited to,
the following services related to infertility: diagnosis and diagnostic tests;
medications; surgery; in vitro fertilization; embryo transfer; artificial
insemination; gamete intra fallopian transfer; zygote intra fallopian transfer;
intracytoplasmic sperm injection; and four completed egg retrievals per
lifetime of the covered person. The School Employees Health Benefits Commission
may provide that coverage for in vitro fertilization, gamete intra fallopian
transfer and zygote intra fallopian transfer shall be limited to a covered
person who: a. has used all reasonable, less expensive and medically
appropriate treatments and is still unable to become pregnant or carry a
pregnancy; b. has not reached the limit of four completed egg retrievals; and
c. is 45 years of age or younger.�
The School Employees Health Benefits
Commission may also provide that coverage for preimplantation genetic testing
with in vitro fertilization be limited to covered persons where:
���� (1)�� both partners are
known carriers of an autosomal recessive disorder;
����
(2)�� one partner is a
known carrier of a single gene autosomal recessive disorder and the partners
have one offspring that has been diagnosed with that recessive disorder;
����
(3)�� one partner is a
known carrier of a single gene autosomal disorder;
����
(4)�� one partner is a
known carrier of a single X-linked disorder; and
(5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability.
����
b.
���
[
For purposes
of
]
As
used in
this section
[
,
]
:
����
[
"infertility"
]
�Infertility�
means a disease or condition that results in the abnormal function of the
reproductive system, as determined pursuant to American Society for
Reproductive Medicine practice guidelines by a physician who is Board Certified
or Board Eligible in Reproductive Endocrinology and Infertility or in
Obstetrics and Gynecology or any one of the following conditions:
���� (1)�� A male is unable to
impregnate a female;
���� (2) A female with a male
partner and under 35 years of age is unable to conceive after 12 months of
unprotected sexual intercourse;
���� (3)�� A female with a male
partner and 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
���� (4)�� A female without a male
partner and under 35 years of age who is unable to conceive after 12 failed
attempts of intrauterine insemination under medical supervision;
���� (5)�� A female without a male
partner and over 35 years of age who is unable to conceive after six failed
attempts of intrauterine insemination under medical supervision;
���� (6)�� Partners are unable to
conceive as a result of involuntary medical sterility;
���� (7)�� A person is unable to
carry a pregnancy to live birth; or
���� (8)�� A previous determination
of infertility pursuant to this section.�
����
�Preimplantation genetic
testing� means a technique used to identify genetic defects in embryos created
through in vitro fertilization before pregnancy.
����
c.
���� The benefits
shall be provided to the same extent as for other pregnancy-related procedures
under the contract, except that the services provided for in this section shall
be performed at facilities that conform to standards established by the
American Society for Reproductive Medicine or the American College of
Obstetricians and Gynecologists. The same copayments, deductibles and benefit
limits shall apply to the diagnosis and treatment of infertility pursuant to
this section as those applied to other medical or surgical benefits under the
contract.� Infertility resulting from voluntary sterilization procedures shall
be excluded under the contract for the coverage required by this section.
(cf: P.L.2017, c.48, s.7)
���� 8.��� This act shall take
effect on the 90th day next following enactment and shall apply to policies or
contracts delivered, issued, or renewed on or after that date.
STATEMENT
���� This bill requires health
insurance carriers to provide coverage of preimplantation genetic testing (PGT)
and in vitro fertilization for covered persons who are not infertile to prevent
certain serious genetic medical conditions from being passed on to offspring
under certain conditions.
���� Under the bill, health
insurance carriers (which include hospital service corporations, medical
service corporations, health maintenance organizations authorized to issue
health benefits plans in New Jersey, group health insurance policies, and any
entities contracted to administer health benefits in connection with the State
Health Benefits Program and School Employees� Health Benefits Program) will be
required to cover PGT with in vitro fertilization even if the covered person is
not infertile, where
���� (1)�� both partners are known
carriers of an autosomal recessive disorder;
���� (2)�� one partner is a known
carrier of a single gene autosomal recessive disorder and the partners have one
offspring that has been diagnosed with that recessive disorder;
���� (3)�� one partner is a known
carrier of a single gene autosomal disorder;
���� (4)�� one partner is a known
carrier of a single X-linked disorder; and
���� (5) the genetic condition, if
passed on to the covered persons� offspring, would result in significant health
problems or severe disability
���� For the purposes of this bill,
�preimplantation genetic testing� is defined as a technique used to identify
genetic defects in embryos created through in vitro fertilization before
pregnancy.