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Wisconsin Legislature: SB566: Bill Text
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SB566: Bill Text
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2025 - 2026 LEGISLATURE
LRB-0166/1
JPC:cdc
2025 SENATE BILL 566
October 24, 2025 - Introduced by Senators
Roys
,
Habush Sinykin
,
Hesselbein
,
Ratcliff
,
Smith
,
Spreitzer
and
Larson
, cosponsored by Representatives
Emerson
,
Vining
,
Andraca
,
Arney
,
Bare
,
Clancy
,
DeSmidt
,
Fitzgerald
,
Goodwin
,
Hysell
,
Joers
,
Johnson
,
Madison
,
Miresse
,
Neubauer
,
Ortiz-Velez
,
Sinicki
,
Stroud
,
Stubbs
,
Subeck
,
Tenorio
and
Palmeri
. Referred to Committee on Insurance, Housing, Rural Issues and Forestry.
SB566,1,3
1
An Act
to create
609.74 and 632.895 (15m) of the statutes;
relating to:
2
coverage of infertility services under health policies and plans and granting
3
rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies and self-insured governmental health plans that cover medical or hospital expenses to cover diagnosis of and treatment for infertility and standard fertility preservation services. Coverage required under the bill must include at least four completed egg retrievals with unlimited embryo transfers in accordance with certain guidelines and single embryo transfer is allowed when recommended and medically appropriate. Policies and plans are prohibited from imposing an exclusion, limitation, or other restriction on coverage of medications of which the bill requires coverage that is not imposed on any other prescription medications covered under the policy or plan. Similarly, policies and plans may not impose any exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction on diagnosis, treatment, or services for which coverage is required under the bill that is different from any exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction imposed on benefits for other services. Also, policies and plans may not impose an exclusion, limitation, or other restriction on diagnosis, treatment, or services for which coverage is required under the bill on the basis that an insured person participates in fertility services provided by or to a third party. Current law refers to health insurance policies as disability insurance policies.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SB566,1
1
Section
1
.
609.74 of the statutes is created to read:
SB566,2,3
2
609.74
Coverage of infertility services.
Defined network plans and
3
preferred provider plans are subject to s. 632.895 (15m).
SB566,2
4
Section
2
.
632.895 (15m) of the statutes is created to read:
SB566,2,5
5
632.895
(15m)
Coverage of infertility services.
(a) In this subsection:
SB566,2,11
6
1. “Diagnosis of and treatment for infertility” means any recommended
7
procedure or medication at the direction of a physician that is consistent with
8
established, published, or approved medical practices or professional guidelines
9
from the American College of Obstetricians and Gynecologists, or its successor
10
organization, or the American Society for Reproductive Medicine, or its successor
11
organization.
SB566,2,13
12
2. “Infertility” means a disease, condition, or status characterized by any of
13
the following:
SB566,3,2
14
a. The failure to establish a pregnancy or carry a pregnancy to a live birth
15
after regular, unprotected sexual intercourse for, if the woman is under the age of
16
35, no longer than 12 months or, if the woman is 35 years of age or older, no longer
1
than 6 months including any time during those 12 months or 6 months that the
2
woman has a pregnancy that results in a miscarriage.
SB566,3,4
3
b. An individual’s inability to reproduce either as a single individual or with a
4
partner without medical intervention.
SB566,3,7
5
c. A physician’s findings based on a patient’s medical, sexual, and
6
reproductive history, age, physical findings, diagnostic testing, or any combination
7
of these factors.
SB566,3,9
8
3. “Self-insured health plan” means a self-insured health plan of the state or
9
a county, city, village, town, or school district.
SB566,3,16
10
4. “Standard fertility preservation service” means a procedure that is
11
consistent with established medical practices or professional guidelines published
12
by the American Society for Reproductive Medicine, or its successor organization, or
13
the American Society of Clinical Oncology, or its successor organization, for a
14
person who has a medical condition or is expected to undergo medication therapy,
15
surgery, radiation, chemotherapy, or other medical treatment that is recognized by
16
medical professionals to directly or indirectly cause a risk of impairment to fertility.
SB566,3,23
17
(b) Subject to pars. (c) to (e), every disability insurance policy and self-insured
18
health plan that provides coverage for medical or hospital expenses shall cover
19
diagnosis of and treatment for infertility and standard fertility preservation
20
services. Coverage required under this paragraph includes at least 4 completed
21
oocyte retrievals with unlimited embryo transfers in accordance with the guidelines
22
of the American Society for Reproductive Medicine or its successor organization and
23
single embryo transfer may be used when recommended and medically appropriate.
SB566,4,2
1
(c) 1. A disability insurance policy or self-insured health plan may not do any
2
of the following:
SB566,4,5
3
a. Impose any exclusions, limitations, or other restrictions on coverage
4
required under par. (b) based on a covered individual’s participation in fertility
5
services provided by or to a 3rd party.
SB566,4,9
6
b. Impose any exclusion, limitation, or other restriction on coverage of
7
medications that are required to be covered under par. (b) that are different from
8
those imposed on any other prescription medications covered under the policy or
9
plan.
SB566,4,15
10
c. Impose any exclusion, limitation, cost-sharing requirement, benefit
11
maximum, waiting period, or other restriction on coverage of the diagnosis of and
12
treatment for infertility and standard fertility preservation services required under
13
par. (b) that is different from an exclusion, limitation, cost-sharing requirement,
14
benefit maximum, waiting period, or other restriction imposed on benefits for
15
services that are covered by the policy or plan and that are not related to infertility.
SB566,4,19
16
2. A disability insurance policy or self-insured health plan shall provide
17
coverage required under par. (b) to any covered individual under the policy or plan,
18
including any covered spouse and nonspouse dependent, to the same extent as other
19
pregnancy-related benefits covered under the policy or plan.
SB566,5,2
20
(d) The commissioner, after consulting with the department of health services
21
on appropriate treatment for infertility, shall promulgate any rules necessary to
22
implement this subsection. Before the promulgation of rules, disability insurance
23
policies and self-insured health plans are considered to comply with the coverage
1
requirements of par. (b) if the coverage conforms to the standards of the American
2
Society for Reproductive Medicine.
SB566,5,4
3
(e) This subsection does not apply to a disability insurance policy that is a
4
health benefit plan described under s. 632.745 (11) (b).
SB566,3
5
Section
3
. Initial applicability.
SB566,5,8
6
(
1
) For policies and plans containing provisions inconsistent with this act, the
7
act first applies to policy or plan years beginning on the effective date of this
8
subsection, except as provided in sub. (
2
).
SB566,5,13
9
(
2
) For policies and plans that are affected by a collective bargaining
10
agreement containing provisions inconsistent with this act, the act first applies to
11
policy or plan years beginning on the effective date of this subsection or on the day
12
on which the collective bargaining agreement is newly established, extended,
13
modified, or renewed, whichever is later.
SB566,4
14
Section
4
. Effective date.
SB566,5,16
15
(
1
)
This act takes effect on the first day of the 4th month beginning after
16
publication.
SB566,5,17
17
(end)
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true
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