AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Amends the current law on health insurance coverage for fertility diagnostic care, standard fertility preservation services, and fertility treatment and requires coverage for any medically necessary ovulation-enhancing drugs and medical services.)

S2460

2026 -- S 2460
========
LC004606
========

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 Mack, Murray, DiMario, Valverde, Lauria, Kallman, Lawson,
Vargas, Gu, and Euer

Date Introduced:
February 06, 2026

Referred To:
Senate Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident
2
and Sickness Insurance Policies" is 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
and for standard fertility-preservation services
.

when
9
a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a
10
covered person. To the extent that a health insurance contract provides reimbursement for a test or
11
procedure used in the diagnosis or treatment of conditions other than infertility, the tests and
12
procedures shall not be excluded from reimbursement when provided attendant to the diagnosis
13
and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)
14
years; provided, that a subscriber copayment not to exceed twenty percent (20%) may be required
15
for those programs and/or procedures the sole purpose of which is the treatment of infertility.
16

(b) For purposes of this section, “infertility” means the condition of an otherwise
17
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
18
one year.
19

(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,

1
this section shall apply to blanket or group policies of insurance.
2

(c) For the purposes of this section, the following terms shall have the following meanings:
3

(1) “Infertility” means:
4

(i) The presence of a condition recognized by a healthcare provider that impacts an
5
individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an
6
individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or
7
any combination of those factors. This condition includes infertility arising from a disability or
8
medical treatments or conditions associated with a disability;
9

(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth
10
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s
11
partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the
12
twelve (12) month time period;
13

(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected
14
sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual
15
and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss
16
does not restart the twelve (12) month time period;
17

(iv) An individual’s inability to establish a pregnancy because the individual or the
18
individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
19

(v) An individual’s increased risk, independently or with the individual’s partner, of
20
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
21

(vi) As defined by the American Society of Reproductive Medicine.
22

(c) For purposes of this section, “standard fertility-preservation services”

(2) "Standard
23
fertility-preservation services"
means procedures
, counseling, products, medications, genetic
24
testing, and services intended to preserve fertility
consistent with established medical practices and
25
professional guidelines published by the American Society for Reproductive Medicine
or
,
the
26
American Society of Clinical Oncology
, or other reputable professional medical organizations
, for
27
an individual who has a medical or genetic condition, including conditions related to a disability or
28
chronic illness, or who is expected to undergo treatment that has a possible side effect of or may
29
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the
30
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material
.
31

(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
32
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
33
processes.
34

(e) For purposes of this section, “may directly or indirectly cause” means treatment with a

LC004606 - Page 2 of 14
1
likely side effect of infertility as established by the American Society for Reproductive Medicine,
2
the American Society of Clinical Oncology, or other reputable professional organizations.
3

(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
4
this section shall apply to blanket or group policies of insurance.
5

(g) The health insurance contract may limit coverage to a lifetime cap of one hundred
6
thousand dollars ($100,000).
7

(d) Coverage for the treatment of infertility under this section shall be provided without
8
discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender
9
identity, genetic information, marital status, national origin, race, religion, sex, or sexual
10
orientation.
11

(e) Coverage for the treatment of infertility under this section shall include, but shall not
12
be limited to:
13

(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those
14

oocyte retrievals or from any oocyte retrieval;
15

(2) The medical costs related to an embryo transfer to be made from or on behalf of an
16
insured to a third party;
17

(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo
18
will be transferred to a surrogate; and
19

(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,
20
but not limited to, preimplantation genetic testing.
21

(f) An insurer described in subsection (a) of this section shall not impose any of the
22
following:
23

(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any
24
other limitations on coverage for the diagnosis and treatment of infertility, including the
25
prescription of fertility medications, different from those imposed on benefits for services not
26
related to infertility;
27

(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage
28
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of
29
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for
30
required benefits;
31

(3) Limitations on coverage based solely on arbitrary factors, including number of
32
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements
33
on, a class protected under § 23-17-19.1, than that provided to other insureds;
34

(4) Impose any limitations on coverage required under this section based on an individual's

LC004606 - Page 3 of 14
1
use of donor gametes, donor embryos or surrogacy;
2

(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that
3
are different from those imposed on any other prescription medications; or
4

(6) Limitations under the policy based on anything other than the medical assessment of
5
an individual’s licensed healthcare provider.
6

(g) An insurer described in subsection (a) of this section shall provide coverage under this
7
section regardless of whether the insured foregoes a particular fertility treatment or procedure, if
8
the insured’s healthcare provider determines that the treatment or procedure is likely to be
9
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
10

(h) This section does not interfere with the clinical judgment of a healthcare provider. Any
11
clinical guidelines used for a policy subject to the requirements of this section shall be based on
12
current guidelines developed by the American Society for Reproductive Medicine or the American
13
Society of Clinical Oncology.
14
SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit
15
Hospital Service Corporations" is hereby amended to read as follows:
16

27-19-23. Coverage for infertility.
17
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for
18
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
19
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
20
for medically necessary expenses of diagnosis and treatment of infertility
for women between the
21
ages of twenty-five (25) and forty-two (42) years
and for standard fertility-preservation services
.

22
when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility
23
to a covered person. To the extent that a nonprofit hospital service corporation provides
24
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than
25
infertility, those tests and procedures shall not be excluded from reimbursement when provided
26
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
27
(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent
28
(20%), may be required for those programs and/or procedures the sole purpose of which is the
29
treatment of infertility.
30

(b) For purposes of this section, “infertility” means the condition of an otherwise
31
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
32
one year.
33

(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
34
this section shall apply to blanket or group policies of insurance.

LC004606 - Page 4 of 14
1

(c) For the purposes of this section, the following terms shall have the following meanings:
2

(1) “Infertility” means:
3

(i) The presence of a condition recognized by a healthcare provider that impacts an
4
individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an
5
individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or
6
any combination of those factors. This condition includes infertility arising from a disability or
7
medical treatments or conditions associated with a disability;
8

(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth
9
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s
10
partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the
11
twelve (12) month time period;
12

(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected
13
sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual
14
and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss
15
does not restart the twelve (12) month time period;
16

(iv) An individual’s inability to establish a pregnancy because the individual or the
17
individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
18

(v) An individual’s increased risk, independently or with the individual’s partner, of
19
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
20

(vi) As defined by the American Society of Reproductive Medicine.
21

(c) For purposes of this section, “standard fertility-preservation services”

(2) "Standard
22
fertility-preservation services"
means procedures
, counseling, products, medications, genetic
23
testing, and services intended to preserve fertility
consistent with established medical practices and
24
professional guidelines published by the American Society for Reproductive Medicine, the
25
American Society of Clinical Oncology
, or other reputable professional medical organizations
, for
26
an individual who has a medical or genetic condition, including conditions related to a disability or
27
chronic illness, or who is expected to undergo treatment that has a possible side effect of or may
28
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the
29
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material
.
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,

LC004606 - Page 5 of 14
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

(d) Coverage for the treatment of infertility under this section shall be provided without
5
discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender
6
identity, genetic information, marital status, national origin, race, religion, sex, or sexual
7
orientation.
8

(e) Coverage for the treatment of infertility under this section shall include, but shall not
9
be limited to:
10

(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those
11

oocyte retrievals or from any oocyte retrieval;
12

(2) The medical costs related to an embryo transfer to be made from or on behalf of an
13
insured to a third party;
14

(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo
15
will be transferred to a surrogate; and
16

(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,
17
but not limited, to preimplantation genetic testing.
18

(f) An insurer described in subsection (a) of this section shall not impose any of the
19
following:
20

(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any
21
other limitations on coverage for the diagnosis and treatment of infertility, including the
22
prescription of fertility medications, different from those imposed on benefits for services not
23
related to infertility;
24

(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage
25
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of
26
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for
27
required benefits;
28

(3) Limitations on coverage based solely on arbitrary factors, including number of
29
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements
30
on, a class protected under § 23-17-19.1, than that provided to other insureds;
31

(4) Impose any limitations on coverage required under this section based on an individual's
32
use of donor gametes, donor embryos or surrogacy;
33

(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that
34
are different from those imposed on any other prescription medications; or

LC004606 - Page 6 of 14
1

(6) Limitations under the policy based on anything other than the medical assessment of
2
an individual’s licensed healthcare provider.
3

(g) An insurer described in subsection (a) of this section shall provide coverage under this
4
section regardless of whether the insured foregoes a particular fertility treatment or procedure, if
5
the insured’s healthcare provider determines that the treatment or procedure is likely to be
6
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
7

(h) This section does not interfere with the clinical judgment of a healthcare provider. Any
8
clinical guidelines used for a policy subject to the requirements of this section shall be based on
9
current guidelines developed by the American Society for Reproductive Medicine or the American
10
Society of Clinical Oncology.
11
SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit
12
Medical Service Corporations" is hereby amended to read as follows:
13

27-20-20. Coverage for infertility.
14
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for
15
delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
16
or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
17
for the medically necessary expenses of diagnosis and treatment of infertility
for women between
18
the ages of twenty-five (25) and forty-two (42) years
and for standard fertility-preservation
19
services
.

when a medically necessary medical treatment may directly or indirectly cause iatrogenic
20
infertility to a covered person. To the extent that a nonprofit medical service corporation provides
21
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than
22
infertility, those tests and procedures shall not be excluded from reimbursement when provided
23
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
24
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent
25
(20%), may be required for those programs and/or procedures the sole purpose of which is the
26
treatment of infertility.
27

(b) For purposes of this section, “infertility” means the condition of an otherwise
28
presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
29
one year.
30

(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
31
this section shall apply to blanket or group policies of insurance.
32

(c) For the purposes of this section, the following terms shall have the following meanings:
33

(1) “Infertility” means:
34

(i) The presence of a condition recognized by a healthcare provider that impacts an

LC004606 - Page 7 of 14
1
individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an
2
individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or
3
any combination of those factors. This condition includes infertility arising from a disability or
4
medical treatments or conditions associated with a disability;
5

(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth
6
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s
7
partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the
8
twelve (12) month time period;
9

(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected
10
sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual
11
and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss
12
does not restart the twelve (12) month time period;
13

(iv) An individual’s inability to establish a pregnancy because the individual or the
14
individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
15

(v) An individual’s increased risk, independently or with the individual’s partner, of
16
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
17

(vi) As defined by the American Society of Reproductive Medicine.
18

(c) For purposes of this section, “standard fertility-preservation services”

(2) "Standard
19
fertility-preservation services"
means procedures
,

counseling, products, medications, genetic
20
testing, and services intended to preserve fertility
consistent with established medical practices and
21
professional guidelines published by the American Society for Reproductive Medicine, the
22
American Society of Clinical Oncology
, or other reputable professional medical organizations
, for
23
an individual who has a medical or genetic condition, including conditions related to a disability or
24
chronic illness, or who is expected to undergo treatment that has a possible side effect of or may
25
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the
26
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material
.
27

(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
28
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
29
processes.
30

(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
31
likely side effect of infertility as established by the American Society for Reproductive Medicine,
32
the American Society of Clinical Oncology, or other reputable professional organizations.
33

(f) The health insurance contract may limit coverage to a lifetime cap of one hundred
34
thousand dollars ($100,000).

LC004606 - Page 8 of 14
1

(d) Coverage for the treatment of infertility under this section shall be provided without
2
discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender
3
identity, genetic information, marital status, national origin, race, religion, sex, or sexual
4
orientation.
5

(e) Coverage for the treatment of infertility under this section shall include, but shall not
6
be limited to:
7

(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those
8

oocyte retrievals or from any oocyte retrieval;
9

(2) The medical costs related to an embryo transfer to be made from or on behalf of an
10
insured to a third party;
11

(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo
12
will be transferred to a surrogate; and
13

(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,
14
but not limited to, preimplantation genetic testing.
15

(f) An insurer described in subsection (a) of this section shall not impose any of the
16
following:
17

(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any
18
other limitations on coverage for the diagnosis and treatment of infertility, including the
19
prescription of fertility medications, different from those imposed on benefits for services not
20
related to infertility;
21

(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage
22
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of
23
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for
24
required benefits;
25

(3) Limitations on coverage based solely on arbitrary factors, including number of
26
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements
27
on, a class protected under § 23-17-19.1, than that provided to other insureds;
28

(4) Impose any limitations on coverage required under this section based on an individual's
29
use of donor gametes, donor embryos or surrogacy;
30

(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that
31
are different from those imposed on any other prescription medications; or
32

(6) Limitations under the policy based on anything other than the medical assessment of
33
an individual’s licensed healthcare provider.
34

(g) An insurer described in subsection (a) of this section shall provide coverage under this

LC004606 - Page 9 of 14
1
section regardless of whether the insured foregoes a particular fertility treatment or procedure, if
2
the insured’s healthcare provider determines that the treatment or procedure is likely to be
3
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
4

(h) This section does not interfere with the clinical judgment of a healthcare provider. Any
5
clinical guidelines used for a policy subject to the requirements of this section shall be based on
6
current guidelines developed by the American Society for Reproductive Medicine or the American
7
Society of Clinical Oncology.
8
SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health
9
Maintenance Organizations" is hereby amended to read as follows:
10

27-41-33. Coverage for infertility.
11
(a) Any health maintenance organization service contract plan or policy delivered, issued
12
for delivery, or renewed in this state, except a contract providing supplemental coverage to
13
Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide
14
coverage for medically necessary expenses of diagnosis and treatment of infertility
for women
15
between the ages of twenty-five (25) and forty-two (42) years
and for standard fertility-preservation
16
services
.

when a medically necessary medical treatment may directly or indirectly cause iatrogenic
17
infertility to a covered person. To the extent that a health maintenance organization provides
18
reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than
19
infertility, those tests and procedures shall not be excluded from reimbursement when provided
20
attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
21
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent
22
(20%), may be required for those programs and/or procedures the sole purpose of which is the
23
treatment of infertility.
24

(b) For purposes of this section, “infertility” means the condition of an otherwise healthy
25
individual who is unable to conceive or sustain a pregnancy during a period of one year.
26

(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
27
this section shall apply to blanket or group policies of insurance.
28

(c) For the purposes of this section, the following terms shall have the following meanings:
29

(1) “Infertility” means:
30

(i) The presence of a condition recognized by a healthcare provider that impacts an
31
individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an
32
individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or
33
any combination of those factors. This condition includes infertility arising from a disability or
34
medical treatments or conditions associated with a disability;

LC004606 - Page 10 of 14
1

(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth
2
after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s
3
partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the
4
twelve (12) month time period;
5

(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected
6
sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual
7
and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss
8
does not restart the twelve (12) month time period;
9

(iv) An individual’s inability to establish a pregnancy because the individual or the
10
individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
11

(v) An individual’s increased risk, independently or with the individual’s partner, of
12
transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
13

(vi) As defined by the American Society of Reproductive Medicine.
14

(c) For purposes of this section, “standard fertility-preservation services”

(2) "Standard
15
fertility-preservation services"
means procedures
,

counseling, products, medications, genetic
16
testing, and services intended to preserve fertility
consistent with established medical practices and
17
professional guidelines published by the American Society for Reproductive Medicine, the
18
American Society of Clinical Oncology
, or other reputable professional medical organizations
, for
19
an individual who has a medical or genetic condition, including conditions related to a disability or
20
chronic illness, or who is expected to undergo treatment that has a possible side effect of or may
21
directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the
22
procurement, cryopreservation, and storage of gametes, embryos, and reproductive material
.
23

(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
24
surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
25
processes.
26

(e) For purposes of this section, “may directly or indirectly cause” means treatment with a
27
likely side effect of infertility as established by the American Society for Reproductive Medicine,
28
the American Society of Clinical Oncology, or other reputable professional organizations.
29

(f) The health insurance contract may limit coverage to a lifetime cap of one hundred
30
thousand dollars ($100,000).
31

(d) Coverage for the treatment of infertility under this section shall be provided without
32
discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender
33
identity, genetic information, marital status, national origin, race, religion, sex, or sexual
34
orientation.

LC004606 - Page 11 of 14
1

(e) Coverage for the treatment of infertility under this section shall include, but shall not
2
be limited to:
3

(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those
4

oocyte retrievals or from any oocyte retrieval;
5

(2) The medical costs related to an embryo transfer to be made from or on behalf of an
6
insured to a third party;
7

(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo
8
will be transferred to a surrogate; and
9

(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including,
10
but not limited to, preimplantation genetic testing.
11

(f) An insurer described in subsection (a) of this section shall not impose any of the
12
following:
13

(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any
14
other limitations on coverage for the diagnosis and treatment of infertility, including the
15
prescription of fertility medications, different from those imposed on benefits for services not
16
related to infertility;
17

(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage
18
for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of
19
infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for
20
required benefits;
21

(3) Limitations on coverage based solely on arbitrary factors, including number of
22
attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements
23
on, a class protected under § 23-17-19.1, than that provided to other insureds;
24

(4) Impose any limitations on coverage required under this section based on an individual's
25
use of donor gametes, donor embryos or surrogacy;
26

(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that
27
are different from those imposed on any other prescription medications; or
28

(6) Limitations under the policy based on anything other than the medical assessment of
29
an individual’s licensed healthcare provider.
30

(g) An insurer described in subsection (a) of this section shall provide coverage under this
31
section regardless of whether the insured foregoes a particular fertility treatment or procedure, if
32
the insured’s healthcare provider determines that the treatment or procedure is likely to be
33
unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
34

(h) This section does not interfere with the clinical judgment of a healthcare provider. Any

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1
clinical guidelines used for a policy subject to the requirements of this section shall be based on
2
current guidelines developed by the American Society for Reproductive Medicine or the American
3
Society of Clinical Oncology.
4
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 amend the current law on health insurance coverage for fertility diagnostic
2
care, standard fertility preservation services, and fertility treatment and would require coverage for
3
any medically necessary ovulation-enhancing drugs and medical services related to prescribing and
4
monitoring the use of ovulation-enhancing drugs that is intended to treat infertility and establish a
5
pregnancy that results in a live birth.
6
This act would take effect on January 1, 2027.
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