Fertility-related services

AN ACT Relating to providing coverage for the diagnosis of 1
infertility, treatment for infertility, and standard fertility 2
preservation services; adding a new section to chapter 48.43 RCW; 3
adding a new section to chapter 41.05 RCW; adding a new section to 4
chapter 74.09 RCW; and creating new sections. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. (1) The legislature finds that:7
(a) According to the federal centers for disease control and 8
prevention, over 12 percent of women of reproductive age in the 9
United States have difficulty becoming pregnant or staying pregnant;10
(b) Infertility is evenly divided between men and women and 11
approximately one-third of cases involve both partners being 12
diagnosed or are unexplained; 13
(c) Increasing accessibility for infertility treatment will 14
expand the state's health services and improve the short and long-15
term health outcomes for the resulting children and mothers, which 16
may also reduce health care costs by reducing adverse outcomes; and17
(d) Insurance coverage reduces disparities in access to care for 18
racial and ethnic minorities as well as for LGBTQ persons.19
H-0233.2
HOUSE BILL 1129
State of Washington 69th Legislature 2025 Regular Session
By Representatives Stonier, Macri, Street, Shavers, Farivar, Simmons,
Tharinger, Parshley, Obras, Fosse, Reeves, Bernbaum, Mena, Fey,
Taylor, Berry, Pollet, Entenman, Alvarado, Reed, Fitzgibbon, Callan,
Cortes, Timmons, Ortiz-Self, Peterson, Goodman, Wylie, Berg, Ormsby,
Lekanoff, Salahuddin, and Hill
Prefiled 12/23/24. Read first time 01/13/25. Referred to Committee
on Health Care & Wellness.
p. 1 HB 1129
(2) The legislature, therefore, intends to provide coverage for 1
the diagnosis of and treatment for infertility, as well as for 2
standard fertility preservation services. 3
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 4
RCW to read as follows: 5
(1) Group health plans issued or renewed on or after January 1, 6
2026, must include coverage for standard fertility preservation 7
services. 8
(2) Group health plans issued or renewed on or after January 1, 9
2027, must include coverage for the diagnosis of and treatment for 10
infertility. Coverage must provide for two completed oocyte 11
retrievals with unlimited embryo transfers in accordance with the 12
guidelines of the American society for reproductive medicine, using 13
single embryo transfer when recommended and medically appropriate.14
(3) The benefits must be provided to enrollees, including covered 15
spouses and covered nonspouse dependents, to the same extent as other 16
pregnancy-related benefits. 17
(4) Group health plans may not include: 18
(a) Any exclusions, limitations, or other restrictions on 19
coverage of fertility medications that are different from those 20
imposed on other prescription medications; 21
(b) Any exclusions, limitations, or other restrictions on 22
coverage of any fertility services based on a covered individual's 23
participation in fertility services provided by or to a third party; 24
or 25
(c) Any deductibles, copayments, coinsurance, benefit maximums, 26
waiting periods, or any other limitations on coverage for the 27
diagnosis of infertility, treatment of infertility, and standard 28
fertility preservation services, except as provided in this section, 29
that are different from those imposed upon benefits for services not 30
related to infertility. 31
(5) For the purposes of this section: 32
(a) "Diagnosis of and treatment for infertility" means the 33
recommended procedures and medications from the direction of a 34
licensed physician or osteopathic physician that are consistent with 35
established, published, or approved medical practices or professional 36
guidelines from the American college of obstetricians and 37
gynecologists or the American society for reproductive medicine.38
p. 2 HB 1129
(b) "Infertility" means a disease, condition, or status 1
characterized by: 2
(i) The failure to establish a pregnancy or to carry a pregnancy 3
to live birth after regular, unprotected sexual intercourse;4
(ii) A person's inability to reproduce either as a single 5
individual or with the person's partner without medical intervention;6
(iii) A licensed physician's or osteopathic physician's findings 7
based on a patient's medical, sexual, and reproductive history, age, 8
physical findings, or diagnostic testing; or 9
(iv) Disability as an impairment of function. 10
(c) "Regular, unprotected sexual intercourse" means no more than 11
12 months of unprotected sexual intercourse for a woman under the age 12
of 35 or no more than six months of unprotected sexual intercourse 13
for a woman 35 years of age or older. Pregnancy resulting in 14
miscarriage does not restart the 12-month or six-month time period to 15
qualify as having infertility. 16
(d) "Standard fertility preservation services" means procedures 17
that are consistent with the established medical practices or 18
professional guidelines published by the American society of 19
reproductive medicine or the American society of clinical oncology 20
for a person who has a medical condition or is expected to undergo 21
medication therapy, surgery, radiation, chemotherapy, or other 22
medical treatment that is recognized by medical professionals to 23
cause a risk of impairment to fertility. 24
NEW SECTION. Sec. 3. A new section is added to chapter 41.05 25
RCW to read as follows: 26
(1) Health plans offered to employees and their covered 27
dependents under this chapter issued or renewed on or after January 28
1, 2026, must include coverage for standard fertility preservation 29
services. 30
(2) Health plans offered to employees and their covered 31
dependents under this chapter issued or renewed on or after January 32
1, 2027, must include coverage for the diagnosis of and treatment for 33
infertility. Coverage must provide for two completed oocyte 34
retrievals with unlimited embryo transfers in accordance with the 35
guidelines of the American society for reproductive medicine, using 36
single embryo transfer when recommended and medically appropriate.37
p. 3 HB 1129
(3) The benefits must be provided to enrollees, including covered 1
spouses and covered nonspouse dependents, to the same extent as other 2
pregnancy-related benefits. 3
(4) Health plans offered to employees and their covered 4
dependents under this chapter, may not include: 5
(a) Any exclusions, limitations, or other restrictions on 6
coverage of fertility medications that are different from those 7
imposed on other prescription medications; 8
(b) Any exclusions, limitations, or other restrictions on 9
coverage of any fertility services based on a covered individual's 10
participation in fertility services provided by or to a third party; 11
or 12
(c) Any deductibles, copayments, coinsurance, benefit maximums, 13
waiting periods, or any other limitations on coverage for the 14
diagnosis of infertility, treatment of infertility, and standard 15
fertility preservation services, except as provided in this section, 16
that are different from those imposed upon benefits for services not 17
related to infertility. 18
(5) For the purposes of this section: 19
(a) "Diagnosis of and treatment for infertility" means the 20
recommended procedures and medications from the direction of a 21
licensed physician or osteopathic physician that are consistent with 22
established, published, or approved medical practices or professional 23
guidelines from the American college of obstetricians and 24
gynecologists or the American society for reproductive medicine.25
(b) "Infertility" means a disease, condition, or status 26
characterized by: 27
(i) The failure to establish a pregnancy or to carry a pregnancy 28
to live birth after regular, unprotected sexual intercourse;29
(ii) A person's inability to reproduce either as a single 30
individual or with the person's partner without medical intervention;31
(iii) A licensed physician's or osteopathic physician's findings 32
based on a patient's medical, sexual, and reproductive history, age, 33
physical findings, or diagnostic testing; or 34
(iv) Disability as an impairment of function. 35
(c) "Regular, unprotected sexual intercourse" means no more than 36
12 months of unprotected sexual intercourse for a woman under the age 37
of 35 or no more than six months of unprotected sexual intercourse 38
for a woman 35 years of age or older. Pregnancy resulting in 39
p. 4 HB 1129
miscarriage does not restart the 12-month or six-month time period to 1
qualify as having infertility. 2
(d) "Standard fertility preservation services" means procedures 3
that are consistent with the established medical practices or 4
professional guidelines published by the American society of 5
reproductive medicine or the American society of clinical oncology 6
for a person who has a medical condition or is expected to undergo 7
medication therapy, surgery, radiation, chemotherapy, or other 8
medical treatment that is recognized by medical professionals to 9
cause a risk of impairment to fertility. 10
NEW SECTION. Sec. 4. A new section is added to chapter 74.09 11
RCW to read as follows: 12
(1) The authority shall provide coverage under this chapter for 13
standard fertility preservation services. 14
(2) The authority or any medicaid managed care organization may 15
not include: 16
(a) Any exclusions, limitations, or other restrictions on 17
coverage of fertility medications that are different from those 18
imposed on other prescription medications; or 19
(b) Any benefit maximums, waiting periods, or any other 20
limitations on coverage for standard fertility preservation services, 21
except as provided in this section, that are different from those 22
imposed upon benefits for services not related to infertility.23
(3) For purposes of this section, "standard fertility 24
preservation services" means procedures that are consistent with the 25
established medical practices or professional guidelines published by 26
the American society of reproductive medicine or the American society 27
of clinical oncology for a person who has a medical condition or is 28
expected to undergo medication therapy, surgery, radiation, 29
chemotherapy, or other medical treatment that is recognized by 30
medical professionals to cause a risk of impairment to fertility.31
NEW SECTION. Sec. 5. This act may be known and cited as the 32
Washington state building families act.33
NEW SECTION. Sec. 6. The insurance commissioner may adopt rules 34
to implement, administer, and enforce section 2 of this act.35
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