Expanding Insurance Coverage/Fertility Care.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 910

Short Title: Expanding Insurance Coverage/Fertility Care. (Public)
Sponsors: Senators Murdock, Chitlik, and Salvador (Primary Sponsors).
Referred to: Rules and Operations of the Senate
April 30, 2026
*S910-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO EXPAND ACCESS TO FERTILITY CARE. 2
Whereas, having a family and nurturing the next generation is a profound human 3
experience that connects us to each other and ensures our communities are able to thrive; and 4
Whereas, infertility is a recognized condition affecting a substantial portion of the 5
adult population and approximately 1 in 6 people experience infertility during their lifetime, a 6
prevalence that spans all income levels and regions; and 7
Whereas, in the United St ates approximately 12 percent of women and 9 percent of 8
men are infertile and these figures likely underrepresent the affected population while 9
underscoring that the condition affects individuals and couples across all demographics and 10
relationship structures; and 11
Whereas, the need for fertility care to build one's family arises from diverse factors 12
and impacts individuals without regard to age, sexual orientation, relationship status, or gender 13
identity; and 14
Whereas, infertility disproportionately affects some communities, including, for 15
example, Black women in the United States are nearly twice as likely to experience infertility as 16
non-Hispanic white women; and 17
Whereas, people with disabilities experience higher rates of infertility, often due to 18
underlying medical conditions, medications, or prior medical interventions; and 19
Whereas, the majority of infertility cases respond to evidence -based medical 20
treatment, and assisted reproductive technologies, including in vitro fertilization (IVF), are safe 21
and effective; and 22
Whereas, fertility preservation techniques, such as gamete or tissue cryopreservation, 23
are recommended for individuals at risk of infertility and medical associations like the American 24
College of Obstetricians and Gynecologists recommend timely referral for fertility preservation 25
when medical treatment may affect future reproductive health; and 26
Whereas, fertility treatment, including fertility preservation, requires healthcare and 27
insurance coverage like other medical conditions; and 28
Whereas, inadequate access to fertility care harms everyone; and 29
Whereas, too few people have insurance coverage for fertility care and without it, 30
many aspects of this care are out of reach and these economic barriers mean that hopeful parents 31
are going into debt, f acing bankruptcy, working extra jobs, and delaying home purchases and 32
other economic milestones in order to build their family; and 33
Whereas, insurance coverage for fertility treatment and preservation supports early, 34
medically appropriate intervention, red uces high -risk pregnancy complications linked with 35
General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 910-First Edition
multiple embryo transfers, and can lower long -term healthcare costs associated with preterm 1
births and neonatal care; and 2
Whereas, ensuring coverage for fertility care fosters family formation, attracts an d 3
retains families, and strengthens public health infrastructure; Now, therefore, 4
The General Assembly of North Carolina enacts: 5
6
PART I. EXPANDING HEALTH INSURANCE COVERAGE OF FERTILITY CARE 7
SECTION 1.1.(a) Article 3 of Chapter 58 of the General Statutes is amended by 8
adding a new section to read: 9
"§ 58-3-241. Fertility and infertility coverage. 10
(a) The following definitions apply in this section: 11
(1) Fertility diagnostic care. – Procedures, products, genetic testing, medications, 12
counseling, including genetic counseling, and services intended to provide 13
information and counseling about an individual 's fertility, including 14
laboratory assessments and imaging studies. 15
(2) Fertility treatment. – Procedures, products, genetic testing, medications , 16
counseling, and services, including in vitro fertilization and assisted 17
reproduction services , that are intended to establish a pregnancy or treat 18
infertility and that are provided in a manner consistent with establi shed 19
medical practice and professional guidelines published by the American 20
Society for Reproductive Medicine, its successor organization, or a 21
comparable organization, including preconception care, procurement, 22
cryopreservation, and storage of gametes, em bryos, or other reproductive 23
tissue. 24
(3) Gamete. – Sperm or eggs. 25
(4) Infertility. – Any of the following: 26
a. The presence of a condition recognized by a licensed healthcare 27
provider that impacts an ind ividual's ability to establish a pregnancy 28
or to carry a pregnancy based on an individual 's medical, sexual, and 29
reproductive history, age, physical findings, diagnostic testing, or any 30
combination of these factors . This in cludes infertility arising from 31
disabilities or from medical treatments or conditions associated with a 32
disability. 33
b. An individual 's inability to establish a pregnancy because the 34
individual, or the individual and the individual 's partner, do not have 35
the necessary gametes to establish a pregnancy. 36
c. The need for medical intervention, including the use of donor gametes 37
or donor embryos, in order to achieve a successful pregnancy , either 38
as an individual or with a partner. 39
d. The inability to establish a pregnancy after regular, unprotected sexual 40
intercourse for a period of no more than 12 months for an intended 41
gestational parent under the age of 35 or of no more than six months 42
for an intended gestational parent who is 35 years of age or older . 43
Pregnancy loss does not restart the required 12 -month or six-month 44
time period under this sub-subdivision. 45
e. An individual's increased risk, independently or with the individual 's 46
partner, of transmitting a serious, inheritable genetic or chromosomal 47
abnormality to a child. 48
f. As defined by the American Society for Reproductive Medicine, its 49
successor organization, or a comparable organization. 50
(5) Reserved for future codification purposes. 51
General Assembly Of North Carolina Session 2025
Senate Bill 910-First Edition Page 3
(6) Standard fertility preservation services. – Counseling, products, medications, 1
procedures, genetic testing, and services intended to preserve fertility that are 2
(i) recommended by a board-certified obstetrician gynecologist, reproductive 3
endocrinologist, or other qualified healthcare provider or (ii) consistent with 4
current medical practices and professional guidelines published by the 5
American Society for Reproductive Medicine, the American Society of 6
Clinical Oncology , or other reputable professional organizations for an 7
individual who has a medical or genetic condition, including conditions 8
related to a disability or chronic illness, or is expected to receive medical 9
treatment that has a side effect , or possible side effect , of a risk to that 10
individual's fertility. 11
(b) A health benefit plan that provides any pregnancy -related benefit shall provide 12
coverage for any covered individual diagnosed with infertility that includes fertility diagnostic 13
care and fertility treatment performed by any licensed healthcare provider acting within the scope 14
of practice of the provider's license. 15
(c) All of the following shall be included as part of coverage required under this section: 16
(1) No fewer than four completed oocyte retrievals. 17
(2) Unlimited embryo transfers from any completed oocyte retrieval , regardless 18
of whether the retrieval was one of those required under subdivision (1) of this 19
subsection. 20
(3) Unlimited cycles of intrauterine insemination. 21
(4) Unlimited intracervical insemination. 22
(5) Standard fertility preservation services, including coverage for procurement, 23
cryopreservation, and storage of gametes, embryos , or other reproductive 24
tissue, when the covered individual has a diagnosed medical or genetic 25
condition that may , directly or indirectly , including through the necessary 26
treatment for the disease or condition, cause impairment of fertility by 27
affecting reproductive organs or processes. Cryopreservation required to be 28
covered under this subdivision shall be covered, at a minimum, for the later 29
of the following periods: 30
a. From the date of cryopreservation until the date any applicable 31
covered individual reaches the age of 35. 32
b. For a period of not less than five years. 33
(d) Coverage under this section shall not include any of the following: 34
(1) Any exclusion, limitation , or other restriction on coverage of fertility 35
medications that are different from those imposed on other prescription 36
medications. 37
(2) Exclusion or denial of coverage of any fertility treatment based on a covered 38
individual's participation in fertility se rvices provided by a third party, 39
including gestational carriers, surrogates, and the donation or use of the third 40
party's genetic material. 41
(3) Any deductible, copayment, coinsurance, benefit maximum , or other 42
limitation on coverage for services rendered in accordance with this section 43
that are different from those imposed upon services not relating to infertility 44
or fertility treatment. 45
(4) Any waiting period for service under this section. 46
(5) The use of any prior diagnosis, an individual 's disability, or prior fertility 47
treatment as a basis for excluding, limiting, or otherwise restricting the access 48
to coverage under this section. 49
(6) Different limitations on coverage for, the provisions of different benefits to, 50
or different requirements on a class of individuals on account of age, ancestry, 51
General Assembly Of North Carolina Session 2025
Page 4 Senate Bill 910-First Edition
color, disability, ethnicity, gender identity, genetic information, marital status, 1
national origin, race, religion, sex, or sexual orientation. 2
(e) No health benefit plan is required to provide coverage for any no nmedical costs 3
relating to the procurement of gametes, donor embryos, or surrogacy services required to be 4
covered by this section." 5
SECTION 1.1.(b) This section becomes effective October 1, 2027, and applies to 6
insurance contracts issued, renewed, or amended on or after that date. 7
SECTION 1.2.(a) G.S. 135-48.51 reads as rewritten: 8
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 9
Statutes. 10
The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 11
… 12
(6a) G.S. 58-3-241, Fertility and infertility coverage. 13
…." 14
SECTION 1.2.(b) This section becomes effective October 1, 2027, and applies as of 15
the start of the next plan year following that date. 16
17
PART II. MEDICAID COVERAGE OF FERTILITY CARE 18
SECTION 2.1.(a) The Department of Health and Human Services, Division of 19
Health Benefits, shall seek approval from the Centers for Medicare and Medicaid Services (CMS) 20
to implement Medicaid coverage for care. This coverage shall include fer tility diagnostic care, 21
any medically necessary ovulation -enhancing drugs, and intrauterine insemination that is 22
intended to treat infertility and achieve a pregnancy that results in a live birth that includes at 23
least three cycles of ovulation -enhancing medication treatment over a Medicaid beneficiary's 24
lifetime. 25
SECTION 2.1.(b) There is appropriated from the General Fund to the Department 26
of Health and Human Services, Division of Health Benefits, the sum of forty-five million dollars 27
($45,000,000) in rec urring funds and associated receipts beginning with the 2026 -2027 fiscal 28
year to be used to implement the new coverage required under subsection (a) of this section. 29
SECTION 2.1.(c) This section becomes effective July 1, 2026. 30
31
PART III. EDUCATION TRAINING MODULE FOR CERTAIN LICENSING BOARDS 32
SECTION 3.1.(a) Article 1 of Chapter 90 of the General Statutes is amended by 33
adding a new section to read: 34
"§ 90-5.5. Certain continuing medical education requirements. 35
In addition to continuing medical education requirements required by the Board under this 36
Article, the Board shall make available to licensees an education training module in accordance 37
with this section. In developing the education training module, the Board shall consult experts in 38
lesbian, gay, bisexual, transgender, and queer family bui lding, the American Society for 39
Reproductive Medicine, and the Society for Assisted Reproductive Technology. The education 40
training module shall provide training to encourage licensees to speak and have effective 41
discussions with their patients and families in an appropriate manner on all of the following: 42
(1) Prevention and elimination of discrimination based on sexual orientation and 43
expression in medical settings. 44
(2) Improving access to services for lesbian, gay, bisexual, transgender, and queer 45
individuals. 46
(3) Options for lesbian, gay, bisexual, transgender, and queer individuals seeking 47
to start or grow their family." 48
SECTION 3.1.(b) G.S. 90-171.42 reads as rewritten: 49
"§ 90-171.42. Continuing education programs. 50
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Senate Bill 910-First Edition Page 5
(a) Upon request, the Board shall grant approval to continuing education programs upon 1
a finding that the program offers an educational experience designed to enhance the practice of 2
nursing. 3
(b) If the program offers to teach nurses to pe rform advance skills, the Board may grant 4
approval for the program and the performance of the advanced skills by those successfully 5
completing the program when it finds that the nature of the procedures taught in the program and 6
the program facilities and faculty are such that a nurse successfully completing the program can 7
reasonably be expected to carry out those procedures safely and competently. 8
(c) In addition to continuing education requirements required by the Board under this 9
Article, the Board shall make available to licensees an education training module in accordance 10
with this subsection. In developing the education training module, the Board shall consult experts 11
in lesbian, gay, bisexual, transgender, and queer family building, the American Society for 12
Reproductive Medicine, and the Society for Assisted Reproductive Technology. T he education 13
training module shall provide training to encourage licensees to speak and have effective 14
discussions with their patients and families in an appropriate manner on all of the following: 15
(1) Prevention and elimination of discrimination based on sexual orientation and 16
expression in medical settings. 17
(2) Improving access to services for lesbian, gay, bisexual, transgender, and queer 18
individuals. 19
(3) Options for lesbian, gay, bisexual, transgender, and queer individuals seeking 20
to start or grow their family." 21
SECTION 3.1.(c) Certified Nurse Midwife Training. – The joint subcommittee of 22
the North Carolina Medical Board and the North Carolina Board of Nursing created pursuant to 23
G.S. 90-18.2 to administer the practice of midwifery under Article 10 A of Chapter 90 of the 24
General Statutes shall adopt permanent rules to make available to licensees an education training 25
module in accordance with this subsection. In developing the education training module, the 26
Board shall consult experts in lesbian, gay, bisexual, transgender, and queer family building, the 27
American Society for Reproductive Medicine, and the Society for Assisted Reproductive 28
Technology. The education training module shall provide training to encourage licensees to 29
speak and have effective discussions with their patients and families in an appropriate manner on 30
all of the following: 31
(1) Prevention and elimination of discrimination based on sexual orientation and 32
expression in medical settings. 33
(2) Improving access to services for lesbian, gay, bisexual, transgender, and queer 34
individuals. 35
(3) Options for lesbian, gay, bisexual, transgender, and queer individuals seeking 36
to start or grow their family. 37
SECTION 3.2. The North Carolina Medical Board and the North Carolina Board of 38
Nursing shall adopt rules to implement the provisions of Section 3.1 of this Part. 39
SECTION 3.3. This Part becomes effective October 1, 2026. 40
41
PART IV. DEPARTMENT OF HEALTH AND HUMAN SERVICES FERTILITY CARE 42
INITIATIVES 43
44
FERTILITY CARE RESOURCE HUB 45
SECTION 4.1.(a) There is appropriated from the General Fund to the Department 46
of Health and Human Services the sum of one million dollars ($1,000,000) in recurring funds 47
beginning with the 2026 -2027 fiscal year to fund statewide operation and maintenance of a 48
fertility care resource hub accessible in person, through the World Wide Web, or through any 49
other means of electronic access, to refer individuals seeking information regarding fertility care 50
and treatment. In establishing and operating the hub funded by this section, t he Department of 51
General Assembly Of North Carolina Session 2025
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Health and Human Services shall partner with healthcare providers, local health departments, 1
community health centers, and other interested stakeholders to ensure that at least all of the 2
following information is available through the fertility care resource hub: 3
(1) Medically accurate, evidence -based information about fertility care options 4
based on practice guidance by the American Society for Reproductive 5
Medicine. 6
(2) Guidance on connecting or receiving referrals to appropriate fertilit y clinics 7
that are members in good standing of the Society for Assisted Reproductive 8
Technology, or another nationally recognized organization of professionals 9
dedicated to the practice of assisted reproductive technologies. 10
(3) Support for navigating health insurance coverage. 11
(4) Sources of financial assistance for fertility-related services. 12
SECTION 4.1.(b) This section becomes effective July 1, 2026. 13
14
STUDY ON FAMILY PLANNING RESOURCES, BENEFITS, AND SERVICES FOR 15
INDIVIDUALS EXPERIENCING DISPARITIES IN ACCESSING FERTILITY CARE 16
SECTION 4.2.(a) There is appropriated from the General Fund to the Department 17
of Health and Human Services, Division of Central Management and Support, Office of Health 18
Equity (the Office), the sum of seventy thousand dollars ($70,000) in nonrecurring funds for the 19
2026-2027 fiscal year to conduct a study on the affordability, accessibility, and practicality of 20
the resources, benefits, and services available to individuals in underrepresented groups 21
experiencing disparities in acc essing fertility care when seeking to expand their families, 22
including individuals who identify as lesbian, gay, bisexual, transgender, gender nonconforming, 23
queer, or question their sexual orientation or gender identity and expression. In conducting this 24
study, the Office shall do all of the following: 25
(1) Examine the availability of assisted reproduction providers in rural and 26
geographically isolated areas of the State. 27
(2) Assess the amount of funding and any program changes that would be 28
necessary to enhance family planning resources, benefits, and services for the 29
growing population of individuals in underrepresented groups experiencing 30
disparities in accessing fertility care as they seek to expand their families. 31
(3) Examine the feasibility of developing statewide training curricula to improve 32
provider competency in the delivery of health and social support services to 33
parents in underrepresented groups experiencing disparities in accessing 34
fertility care as they seek to expand their families. 35
(4) Examine the extent to which out-of-pocket costs associated with becoming a 36
parent are impacted by sexual orientation, gender identity, or any other factor 37
or characteristic associated with experiencing disparity in accessing fertility 38
care. 39
(5) Recommend best p ractices for increasing access to available resources, 40
benefits, and services and eliminating disparities in this area for individuals in 41
underrepresented groups experiencing disparities in accessing fertility care as 42
they seek to expand their families. 43
(6) Make recommendations to improve the resources, benefits, and services 44
available to individuals in underrepresented groups experiencing disparities in 45
accessing fertility care, with respect to parentage, including, but not limited 46
to, adoption, surrogacy, and assistive reproductive technology. 47
(7) Make recommendations regarding education and training for health care 48
providers and providers of family planning services to improve cultural 49
competency and increase referrals to relevant resources. 50
General Assembly Of North Carolina Session 2025
Senate Bill 910-First Edition Page 7
SECTION 4.2.(b) At the conclusion of the study, the Office shall develop 1
recommendations for improving access to resources, benefits, and services for individuals in 2
underrepresented groups experiencing disparities in accessing fertility care as they seek to 3
expand their families. In formulating these recommendations, the Office shall take into account 4
the best policies and practices of other states and jurisdictions. Additionally, the Office may 5
consult with experts, hold regular public meetings and fact -finding hearings, and host other 6
public forums as the Office considers necessary in fulfilling this charge. 7
SECTION 4.2.(c) The Office may contract with a third party to conduct the study 8
authorized by this section as long as the third party has a demonstrated ca pacity to (i) conduct 9
research that meets academic peer -review standards, specifically in the analysis of both 10
quantitative and qualitative data, and (ii) disseminate study findings in a clear and accessible 11
format. 12
SECTION 4.2.(d) The Office may enter into a memorandum of understanding with 13
other State agencies, academic institutions, or research centers located in the State that are in 14
possession of or have access to the data necessary to complete this study, including the North 15
Carolina State Center for Health Statistics, the Carolina Center for Health Informatics, and the 16
Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. 17
SECTION 4.2.(e) The Office shall submit its findings and recommendations, 18
including any recommended legislative changes, to the Joint Legislative Oversight Committee 19
on Health and Human Services and the Fiscal Research Division by April 1, 2028. 20
SECTION 4.2.(f) This section becomes effective July 1, 2026. 21
22
PART V. PROTECTION O F THE RIGHT TO A CCESS ASSISTED REPRODUCTIVE 23
TECHNOLOGY AND CONTRACEPTIVES 24
SECTION 5.1. Chapter 90 of the General Statutes is amended by adding a new 25
Article to read: 26
"Article 1Q. 27
"Assisted Reproductive Technology and Contraceptive Rights. 28
"§ 90-21.195. Definitions. 29
As used in this Article, the following terms have the following meanings: 30
(1) Assisted reproductive technology. – All treatments or procedures that include 31
the handling of human oocytes or human embryos, including in vitro 32
fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer. 33
(2) Contraception. – An action taken to prevent pregnancy, including the use of 34
contraceptives, emergency contraceptives, and sterilization procedures. 35
(3) Contraceptive. – Any device, medication, biological product, or procedure 36
that is intended for use in the prevention of pregnancy, whether specifically 37
intended to prevent pregnancy or for other health needs, and that is legally 38
marketed under the federal Food, Drug, and Cosmetic Act (21 U.S.C. § 301, 39
et seq.). 40
(4) Health care provider. – Either of the following: 41
a. An individual who is licensed, certified, or otherwise authorized under 42
this Chapter to provide health care services in the ordinary course of 43
business or practice of a profession or in an approved education or 44
training program. 45
b. A health care facility licensed under Chapter 131E of the General 46
Statutes to provide health care services to patients. 47
The term "health care provider " includes (i) an agent or employee of a 48
health care faci lity that is licensed, certified, or otherwise authorized to 49
provide health care services , (ii) the officers and directors of a health care 50
General Assembly Of North Carolina Session 2025
Page 8 Senate Bill 910-First Edition
facility, and (iii) an agent or employee of a health care provider who is 1
licensed, certified, or otherwise authorized to provide health care services. 2
(5) Health care service. – A health or medical procedure or service rendered by a 3
health care provider that meets either of the following criteria: 4
a. Provides testing, diagnosis, or treatment of a health condition, illness, 5
injury, or disease. 6
b. Dispenses drugs, medical devices, medical appliances, or medical 7
goods for the treatment of a health condition, illness, injury, or disease. 8
"§ 90-21.196. Right to access assisted reproductive technology and contraceptives. 9
It is the intent of the General Assembly to clearly and unambiguously acknowledge the right 10
of an individual to perform, and the right of an individual to receive or use, assisted reproductive 11
technology, contraceptives, or both in this State. To that end , and n otwithstanding any other 12
provision of law, an individual has a right to engage in activities associated with assisted 13
reproductive technology and contraception. The laws of this State do not prohibit an activity 14
associated with assisted reproductive technology or contraception. 15
"§ 90-21.197. Construction. 16
Nothing in this Article shall be construed to prohibit the enforcement of health and safety 17
laws related to the operation of health care facilities or the pr ovision of health care services by 18
health care providers." 19
20
PART VI. EFFECTIVE DATE 21
SECTION 6.1. Except as otherwise provided, this act is effective when it becomes 22
law. 23