AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Mandates all insurance contracts, plans or policies provide insurance coverage for the expense of diagnosing and treating infertility, for women between the ages of twenty-five (25) and forty-two (42) years.)

S2382

2026 -- S 2382
========
LC004261
========

STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Senators Urso, Murray, Quezada, Britto, Euer, Bissaillon, Mack, Bell,
and Vargas

Date Introduced:
January 30, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Sections 27-18-30 and 27-18-52 of the General Laws in Chapter 27-18
2
entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows:
3

27-18-30. Health insurance contracts — Infertility.
4
(a) Any health insurance contract, plan, or policy delivered or issued for delivery or
5
renewed in this state, except contracts providing supplemental coverage to Medicare or other
6
governmental programs, that includes pregnancy-related benefits, shall provide coverage for
7
medically necessary expenses of diagnosis and treatment of infertility for women between the ages
8
of twenty-five (25) and forty-two (42) years
, including preimplantation genetic diagnosis (PGD) in
9
conjunction with in vitro fertilization (IVF) subject to the provision of subsection (i) of this section,

10
and for standard fertility-preservation services when a medically necessary medical treatment may
11
directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health
12
insurance contract provides reimbursement for a test or procedure used in the diagnosis or treatment
13
of conditions other than infertility, the tests and procedures shall not be excluded from
14
reimbursement when provided attendant to the diagnosis and treatment of infertility for women
15
between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber
16
copayment not to exceed twenty percent (20%) may be required for those programs and/or
17
procedures the sole purpose of which is the treatment of infertility.
18
(b) For purposes of this section, “infertility” means the condition of an otherwise
19
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of

1
one year.
2
(c) For purposes of this section, “standard fertility-preservation services” means
3
procedures consistent with established medical practices and professional guidelines published by
4
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
5
other reputable professional medical organizations.
6
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
7
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
8
processes.
9
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
10
likely side effect of infertility as established by the American Society for Reproductive Medicine,
11
the American Society of Clinical Oncology, or other reputable professional organizations.
12
(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
13
this section shall apply to blanket or group policies of insurance.
14
(g) The health insurance contract may limit coverage to a lifetime cap of one hundred
15
thousand dollars ($100,000).
16

(h) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
17
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
18
disorders prior to their transfer to the uterus.
19

(i) Any health insurance contract, plan, or policy shall only be required to provide coverage,
20
for preimplantation genetic diagnosis (PGD) upon the following conditions:
21

(1) The PGD is recommended or ordered by a healthcare provider acting within the
22
provider's scope of practice;
23

(2) The PGD is recommended or ordered to address, treat, diagnosis a particular risk,
24
specific health danger or specific genetic risk condition;
25

(3) The condition or circumstances of the insured patient fulfill the specific criteria,
26
requirements or stipulations recommended by nationally recognized clinical practice guidelines for
27
preimplantation genetic diagnosis (PGD).
28

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
29
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
30
of evidence and an assessment of the benefits, and risks of alternative care options intended to
31
optimize patient care developed by independent organization professional societies utilizing a
32
transparent methodology and reporting structure and with a conflict-of-interest policy.
33

(ii) Nothing in this subsection shall be construed to prevent medical management or
34
utilization review of their services, including preauthorization, to ensure that such services are

LC004261 - Page 2 of 15
1
consistent with nationally recognized clinical practice guidelines for PGD.
2

27-18-52. Genetic testing.
3
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and
4
providers shall be prohibited from releasing genetic information without prior written authorization
5
of the individual. Written authorization shall be required for each disclosure and include to whom
6
the disclosure is being made. An exception shall exist for those participating in research settings
7
governed by the Federal Policy for the Protection of Human Research Subjects (also known as
8
“The Common Rule”). Tests conducted purely for research are excluded from the definition, as are
9
tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
10
(b) No individual or group health insurance contract, plan, or policy delivered, issued for
11
delivery, or renewed in this state that provides health insurance medical coverage that includes
12
coverage for physician services in a physician’s office, and every policy that provides major
13
medical or similar comprehensive-type coverage excluding disability income, long-term care, and
14
insurance supplemental policies that only provide coverage for specified diseases or other
15
supplemental policies, shall:
16
(1) Use a genetic test or request for genetic tests or the results of a genetic test to reject,
17
deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect
18
a group or an individual health insurance policy, contract, or plan;
19
(2) Request or require a genetic test for the purpose of determining whether or not to issue
20
or renew an individual’s health benefits coverage, to set reimbursement/copay levels, or determine
21
covered benefits and services;
22
(3) Release the results of a genetic test without the prior written authorization of the
23
individual from whom the test was obtained, except in a format whereby individual identifiers are
24
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
25
of information pursuant to this section may use or disclose this information solely to carry out the
26
purpose for which the information was disclosed. Authorization shall be required for each
27
redisclosure; an exception shall exist for participating in research settings governed by the Federal
28
Policy for the Protection of Human Research Subjects (also known as “The Common Rule”);
29
(4) Request or require information as to whether an individual has ever had a genetic test,
30
or participated in genetic testing of any kind, whether for clinical or research purposes.
31
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
32
RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related
33
genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those purposes include
34
predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or

LC004261 - Page 3 of 15
1
prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be
2
included provided there is an approved release by a parent or guardian. Tests for metabolites are
3
covered only when they are undertaken with high probability that an excess of deficiency of the
4
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
5
mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs
6
or for HIV infections.
7

(d) Any health insurance contract, plan, or policy delivered or issued for delivery or
8
renewed in this state, except contracts providing supplemental coverage to Medicare or other
9
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
10
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)
11
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
12
in vitro fertilization (IVF). For purposes of this section:
13

(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
14
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
15
to the uterus;
16

(2) "Infertility" means the condition of an otherwise presumably healthy individual who is
17
unable to conceive or sustain a pregnancy during a period of one year.
18

(3) Any health insurance contract, plan, or policy that provides coverage, for
19
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
20
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
21
and as recommended by nationally recognized clinical practice guidelines for preimplantation
22
genetic diagnosis (PGD).
23

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
24
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
25
of evidence and an assessment of the benefits, and risks of alternative care options intended to
26
optimize patient care developed by independent organization professional societies utilizing a
27
transparent methodology and reporting structure and with a conflict-of-interest policy.
28

(ii) Nothing in this subsection shall be construed to prevent medical management or
29
utilization review of their services, including preauthorization, to ensure that such services are
30
consistent with nationally recognized clinical practice guidelines for the detection of lung cancer.
31
SECTION 2. Sections 27-19-23 and 27-19-44 of the General Laws in Chapter 27-19
32
entitled "Nonprofit Hospital Service Corporations" are hereby amended to read as follows:
33

27-19-23. Coverage for infertility.
34
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for

LC004261 - Page 4 of 15
1
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
2
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
3
for medically necessary expenses of diagnosis and treatment of infertility for women between the
4
ages of twenty-five (25) and forty-two (42) years
, including preimplantation genetic diagnosis
5
(PGD) in conjunction with in vitro fertilization (IVF) subject to the provision of subsection (h) of
6
this section,
and for standard fertility-preservation services when a medically necessary medical
7
treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent
8
that a nonprofit hospital service corporation provides reimbursement for a test or procedure used
9
in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall
10
not be excluded from reimbursement when provided attendant to the diagnosis and treatment of
11
infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that
12
a subscriber copayment, not to exceed twenty percent (20%), may be required for those programs
13
and/or procedures the sole purpose of which is the treatment of infertility.
14
(b) For purposes of this section, “infertility” means the condition of an otherwise
15
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
16
one year.
17
(c) For purposes of this section, “standard fertility-preservation services” means
18
procedures consistent with established medical practices and professional guidelines published by
19
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
20
other reputable professional medical organizations.
21
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
22
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
23
processes.
24
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
25
likely side effect of infertility as established by the American Society for Reproductive Medicine,
26
the American Society of Clinical Oncology, or other reputable professional organizations.
27
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred
28
thousand dollars ($100,000).
29

(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
30
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
31
disorders prior to their transfer to the uterus.
32

(h) Any health insurance contract, plan, or policy shall only be required to provide
33
coverage, for preimplantation genetic diagnosis (PGD) upon the following conditions:
34

(1) The PGD is recommended or ordered by a healthcare provider acting within the

LC004261 - Page 5 of 15
1
provider's scope of practice;
2

(2) The PGD is recommended or ordered to address, treat, diagnosis a particular risk,
3
specific health danger or specific genetic risk condition;
4

(3) The condition or circumstances of the insured patient fulfill the specific criteria,
5
requirements or stipulations recommended by nationally recognized clinical practice guidelines for
6
preimplantation genetic diagnosis (PGD).
7

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
8
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
9
of evidence and an assessment of the benefits, and risks of alternative care options intended to
10
optimize patient care developed by independent organization professional societies utilizing a
11
transparent methodology and reporting structure and with a conflict-of-interest policy.
12

(ii) Nothing in this subsection shall be construed to prevent medical management or
13
utilization review of their services, including preauthorization, to ensure that such services are
14
consistent with nationally recognized clinical practice guidelines for PGD.
15

27-19-44. Genetic testing.
16
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and
17
providers shall be prohibited from releasing genetic information without prior written authorization
18
of the individual. Written authorization shall be required for each disclosure and include to whom
19
the disclosure is being made. An exception shall exist for those participating in research settings
20
governed by the federal policy for the protection of human research subjects (also known as “The
21
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests
22
for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
23
(b) No nonprofit health service corporation subject to the provisions of this chapter shall:
24
(1) Use a genetic test or request for a genetic test or the results of a genetic test or other
25
genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the
26
terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or
27
plan;
28
(2) Request or require a genetic test for the purpose of determining whether or not to issue
29
or renew a group, individual health benefits coverage, to set reimbursement/copay levels, or
30
determine covered benefits and services;
31
(3) Release the results of a genetic test without the prior written authorization of the
32
individual from whom the test was obtained, except in a format by which individual identifiers are
33
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
34
of information pursuant to this section may use or disclose the information solely to carry out the

LC004261 - Page 6 of 15
1
purpose for which the information was disclosed. Authorization shall be required for each
2
redisclosure. An exception shall exist for participation in research settings governed by the federal
3
policy for the protection of human research subjects (also known as “The Common Rule”); or
4
(4) Request or require information as to whether an individual has ever had a genetic test,
5
or participated in genetic testing of any kind, whether for clinical or research purposes.
6
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
7
RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related
8
genotypes, mutations, phenotypes, or karyotypes for clinical purposes. These purposes include
9
predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or
10
prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be
11
included provided there is an approved release by a parent or guardian. Tests for metabolites are
12
covered only when they are undertaken with high probability that an excess of deficiency of the
13
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
14
mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs
15
or for HIV infection.
16

(d) Any health insurance contract, plan, or policy delivered or issued for delivery or
17
renewed in this state, except contracts providing supplemental coverage to Medicare or other
18
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
19
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)
20
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
21
in vitro fertilization (IVF). For purposes of this section:
22

(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
23
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
24
to the uterus;
25

(2) "Infertility" means the condition of an otherwise presumably healthy individual who is
26
unable to conceive or sustain a pregnancy during a period of one year.
27

(3) Any health insurance contract, plan, or policy that provides coverage, for
28
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
29
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
30
and as recommended by nationally recognized clinical practice guidelines for preimplantation
31
genetic diagnosis (PGD).
32

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
33
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
34
of evidence and an assessment of the benefits, and risks of alternative care options intended to

LC004261 - Page 7 of 15
1
optimize patient care developed by independent organization professional societies utilizing a
2
transparent methodology and reporting structure and with a conflict-of-interest policy.
3

(ii) Nothing in this subsection shall be construed to prevent medical management or
4
utilization review of their services, including preauthorization, to ensure that such services are
5
consistent with nationally recognized clinical practice guidelines for PGD.
6
SECTION 3. Sections 27-20-20 and 27-20-39 of the General Laws in Chapter 27-20
7
entitled "Nonprofit Medical Service Corporations" are hereby amended to read as follows:
8

27-20-20. Coverage for infertility.
9
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for
10
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
11
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
12
for the medically necessary expenses of diagnosis and treatment of infertility for women between
13
the ages of twenty-five (25) and forty-two (42) years
, including preimplantation genetic diagnosis
14
(PGD) in conjunction with in vitro fertilization (IVF) subject to the provision of subsection (i) of
15
this section,
and for standard fertility-preservation services when a medically necessary medical
16
treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent
17
that a nonprofit medical service corporation provides reimbursement for a test or procedure used
18
in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall
19
not be excluded from reimbursement when provided attendant to the diagnosis and treatment of
20
infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that
21
subscriber copayment, not to exceed twenty percent (20%), may be required for those programs
22
and/or procedures the sole purpose of which is the treatment of infertility.
23
(b) For purposes of this section, “infertility” means the condition of an otherwise
24
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
25
one year.
26
(c) For purposes of this section, “standard fertility-preservation services” means
27
procedures consistent with established medical practices and professional guidelines published by
28
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
29
other reputable professional medical organizations.
30
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
31
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
32
processes.
33
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
34
likely side effect of infertility as established by the American Society for Reproductive Medicine,

LC004261 - Page 8 of 15
1
the American Society of Clinical Oncology, or other reputable professional organizations.
2
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred
3
thousand dollars ($100,000).
4

(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
5
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
6
disorders prior to their transfer to the uterus.
7

(h) Any health insurance contract, plan, or policy that provides coverage, for
8
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
9
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
10
and as recommended by nationally recognized clinical practice guidelines for preimplantation
11
genetic diagnosis (PGD).
12

(i) Any health insurance contract, plan, or policy shall only be required to provide coverage,
13
for preimplantation genetic diagnosis (PGD) upon the following conditions:
14

(1) The PGD is recommended or ordered by a healthcare provider acting within the
15
provider's scope of practice;
16

(2) The PGD is recommended or ordered to address, treat, diagnosis a particular risk,
17
specific health danger or specific genetic risk condition;
18

(3) The condition or circumstances of the insured patient fulfill the specific criteria,
19
requirements or stipulations recommended by nationally recognized clinical practice guidelines for
20
preimplantation genetic diagnosis (PGD).
21

(i) Nothing in this subsection shall be construed to prevent medical management or
22
utilization review of their services, including preauthorization, to ensure that such services are
23
consistent with nationally recognized clinical practice guidelines for PGD.
24

27-20-39. Genetic testing.
25
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and
26
providers shall be prohibited from releasing genetic information without prior written authorization
27
of the individual. Written authorization shall be required for each disclosure and include to whom
28
the disclosure is being made. An exception shall exist for those participating in research settings
29
governed by the federal policy for the protection of human research subjects (also known as “The
30
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests
31
for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
32
(b) No nonprofit health insurer subject to the provisions of this chapter shall:
33
(1) Use a genetic test or request for a genetic test or the results of a genetic test to reject,
34
deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect

LC004261 - Page 9 of 15
1
a group or individual’s health insurance policy, contract, or plan;
2
(2) Request or require a genetic test for the purpose of determining whether or not to issue
3
or renew health benefits coverage, to set reimbursement/copay levels, or determine covered
4
benefits and services;
5
(3) Release the results of a genetic test without the prior written authorization of the
6
individual from whom the test was obtained, except in a format by which individual identifiers are
7
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
8
of information pursuant to this section may use or disclose the information solely to carry out the
9
purpose for which the information was disclosed. Authorization shall be required for each
10
redisclosure. An exception shall exist for participation in research settings governed by the federal
11
policy for the protection of human research subjects (also known as “The Common Rule”); or
12
(4) Request or require information as to whether an individual has ever had a genetic test,
13
or participated in genetic testing of any kind, whether for clinical or research purposes.
14
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
15
RNA, chromosomes, proteins, and certain metabolites in order to detect heritable disease-related
16
genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those purposes include
17
predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or
18
prognosis. Prenatal, newborn, and carrier screening, as well as testing in high-risk families, may be
19
included provided there is an approved release by a parent or guardian. Tests for metabolites are
20
covered only when they are undertaken with high probability that an excess of deficiency of the
21
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
22
mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs
23
or for HIV infections.
24

(d) Any health insurance contract, plan, or policy delivered or issued for delivery or
25
renewed in this state, except contracts providing supplemental coverage to Medicare or other
26
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
27
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)
28
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
29
in vitro fertilization (IVF). For purposes of this section:
30

(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
31
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
32
to the uterus;
33

(2) "Infertility" means the condition of an otherwise presumably healthy individual who is
34
unable to conceive or sustain a pregnancy during a period of one year.

LC004261 - Page 10 of 15
1

(3) Any health insurance contract, plan, or policy that provides coverage, for
2
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
3
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
4
and as recommended by nationally recognized clinical practice guidelines for preimplantation
5
genetic diagnosis (PGD).
6

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
7
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
8
of evidence and an assessment of the benefits, and risks of alternative care options intended to
9
optimize patient care developed by independent organization professional societies utilizing a
10
transparent methodology and reporting structure and with a conflict-of-interest policy.
11

(ii) Nothing in this subsection shall be construed to prevent medical management or
12
utilization review of their services, including preauthorization, to ensure that such services are
13
consistent with nationally recognized clinical practice guidelines for PGD.
14
SECTION 4. Sections 27-41-33 and 27-41-53 of the General Laws in Chapter 27-41
15
entitled "Health Maintenance Organizations" are hereby amended to read as follows:
16

27-41-33. Coverage for infertility.
17
(a) Any health maintenance organization service contract plan or policy delivered, issued
18
for delivery, or renewed in this state, except a contract providing supplemental coverage to
19
Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide
20
coverage for medically necessary expenses of diagnosis and treatment of infertility for women
21
between the ages of twenty-five (25) and forty-two (42) years
, including preimplantation genetic
22
diagnosis (PGD) in conjunction with in vitro fertilization (IVF) subject to the provision of
23
subsection (i) of this section,
and for standard fertility-preservation services when a medically
24
necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered
25
person. To the extent that a health maintenance organization provides reimbursement for a test or
26
procedure used in the diagnosis or treatment of conditions other than infertility, those tests and
27
procedures shall not be excluded from reimbursement when provided attendant to the diagnosis
28
and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)
29
years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be required
30
for those programs and/or procedures the sole purpose of which is the treatment of infertility.
31
(b) For purposes of this section, “infertility” means the condition of an otherwise healthy
32
individual who is unable to conceive or sustain a pregnancy during a period of one year.
33
(c) For purposes of this section, “standard fertility-preservation services” means
34
procedures consistent with established medical practices and professional guidelines published by

LC004261 - Page 11 of 15
1
the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
2
other reputable professional medical organizations.
3
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
4
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
5
processes.
6
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
7
likely side effect of infertility as established by the American Society for Reproductive Medicine,
8
the American Society of Clinical Oncology, or other reputable professional organizations.
9
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred
10
thousand dollars ($100,000).
11

(g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
12
technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
13
disorders prior to their transfer to the uterus.
14

(h) Any health insurance contract, plan, or policy that provides coverage, for
15
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
16
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
17
and as recommended by nationally recognized clinical practice guidelines for preimplantation
18
genetic diagnosis (PGD).
19

(i) Any health insurance contract, plan, or policy shall only be required to provide coverage,
20
for preimplantation genetic diagnosis (PGD) upon the following conditions:
21

(1) The PGD is recommended or ordered by a healthcare provider acting within the
22
provider's scope of practice;
23

(2) The PGD is recommended or ordered to address, treat, diagnosis a particular risk,
24
specific health danger or specific genetic risk condition;
25

(3) The condition or circumstances of the insured patient fulfill the specific criteria,
26
requirements or stipulations recommended by nationally recognized clinical practice guidelines for
27
preimplantation genetic diagnosis (PGD).
28

(i) Nothing in this subsection shall be construed to prevent medical management or
29
utilization review of their services, including preauthorization, to ensure that such services are
30
consistent with nationally recognized clinical practice guidelines for PGD.
31

27-41-53. Genetic testing.
32
(a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans, and
33
providers shall be prohibited from releasing genetic information without prior written authorization
34
of the individual. Written authorization shall be required for each disclosure and include to whom

LC004261 - Page 12 of 15
1
the disclosure is being made. An exception shall exist for those participating in research settings
2
governed by the federal policy for the protection of human research subjects (also known as “The
3
Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests
4
for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
5
(b) No health maintenance organization subject to the provisions of this chapter shall:
6
(1) Use a genetic test or request for genetic test or the results of a genetic test to reject,
7
deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect
8
a group or an individual’s health insurance policy contract, or plan;
9
(2) Request or require a genetic test for the purpose of determining whether or not to issue
10
or renew an individual’s health benefits coverage, to set reimbursement/copay levels, or determine
11
covered benefits and services;
12
(3) Release the results of a genetic test without the prior written authorization of the
13
individual from whom the test was obtained, except in a format where individual identifiers are
14
removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
15
of information pursuant to this section may use or disclose the information solely to carry out the
16
purpose for which the information was disclosed. Authorization shall be required for each re-
17
disclosure. An exception shall exist for participation in research settings governed by the federal
18
policy for the protection of human research subjects (also known as “The Common Rule”); or
19
(4) Request or require information as to whether an individual has ever had a genetic test,
20
or participated in genetic testing of any kind, whether for clinical or research purposes.
21
(c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
22
RNA, chromosomes, protein, and certain metabolites in order to detect heritable inheritable
23
disease-related genotypes, mutations, phenotypes, or karyotypes for clinical purposes. Those
24
purposes include predicting risk of disease, identifying carriers, establishing prenatal and clinical
25
diagnosis or prognosis. Prenatal, newborn, and carrier screening, and testing in high-risk families
26
may be included provided there is an approved release by a parent or guardian. Tests for metabolites
27
are covered only when they are undertaken with high probability that an excess or deficiency of the
28
metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
29
mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs
30
or for HIV infections.
31

(d) Any health insurance contract, plan, or policy delivered or issued for delivery or
32
renewed in this state, except contracts providing supplemental coverage to Medicare or other
33
governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
34
expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)

LC004261 - Page 13 of 15
1
and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
2
in vitro fertilization (IVF). For purposes of this section:
3

(1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
4
with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
5
to the uterus;
6

(2) "Infertility" means the condition of an otherwise presumably healthy individual who is
7
unable to conceive or sustain a pregnancy during a period of one year.
8

(3) Any health insurance contract, plan, or policy that provides coverage, for
9
preimplantation genetic diagnosis (PGD) pursuant to subsection (a) of this section, shall do so only
10
upon the recommendation of a healthcare provider acting within the provider's scope of practice,
11
and as recommended by nationally recognized clinical practice guidelines for preimplantation
12
genetic diagnosis (PGD).
13

(i) For the purpose of this subsection, "nationally recognized clinical practice guidelines"
14
means evidence-based, peer reviewed clinical practice guidelines informed by a systematic review
15
of evidence and an assessment of the benefits, and risks of alternative care options intended to
16
optimize patient care developed by independent organization professional societies utilizing a
17
transparent methodology and reporting structure and with a conflict-of-interest policy.
18

(ii) Nothing in this subsection shall be construed to prevent medical management or
19
utilization review of their services, including preauthorization, to ensure that such services are
20
consistent with nationally recognized clinical practice guidelines for PGD.
21
SECTION 5. This act shall take effect on January 1, 2027.
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would mandate all insurance contracts, plans or policies provide insurance
2
coverage for the expense of diagnosing and treating infertility, for women between the ages of
3
twenty-five (25) and forty-two (42) years including preimplantation genetic diagnosis (PGD) in
4
conjunction with in vitro fertilization (IVF) only on the recommendation of a healthcare provider
5
acting within the scope of their practice.
6
This act would take effect on January 1, 2027.
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LC004261 - Page 15 of 15