BILL NUMBER: A7303
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     PURPOSE OR GENERAL IDEA OF BILL:
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     The purpose of this bill is to extend health insurance coverage to
     include the diagnosis and treatment of infertility.

     SUMMARY OF SPECIFIC PROVISIONS:
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     This bill would:

     -- Require medical insurance policies for hospital coverage and
     surgical medical care to include diagnosis and treatment of medical
     conditions which result in infertility.

     -- Require certain health insurance policies to cover the diagnosis
     and treatment of infertility including but not limited to drug
     therapy, artificial insemination, in vitro fertilization,
     intracytoplasmic sperm injection, gamete donation, embryo donation,
     assisted hatching, uterine embryo lavage, embryo transfer, gamete
     intrafallopian tube transfer, zygote intrafallopian tube transfer, low
     tubal ovum transfer and any other medically indicated service or
     procedure that is used to treat infertility or induce pregnancy.

     -- Permit these coverages to be subject to annual deductibles and
     coinsurance deemed appropriate by the Superintendent and consistent
     with those established for other benefits within a given policy.

     -- Limit coverage for in vitro fertilization, intracytoplasmic sperm
     injection, assisted hatching, gamete donation, embryo donation, embryo
     transfer, gamete intrafallopian tube transfer or zygote intrafallopian
     tube transfer to four completed embryo transfers, except that if a
     live birth follows a completed embryo transfer, then two more
     completed embryo transfers would be covered. Also, these procedures
     would be provided only if:

     -- the individual has been unable to attain or sustain a successful
     pregnancy through reasonable, less costly medically appropriate
     covered infertility treatments;

     -- the procedures are performed at medical facilities that conform
     with the American College of Obstetric and Gynecology (ACOG) or the
     American Society for Reproductive Medicine's (ASRM) minimal guidelines
     and standards for assisted reproductive technology.

     JUSTIFICATION:
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     Infertility is a disease of the reproductive system that impairs one
     of the body's most basic functions: the conception of children. Yet,
     many insurance policies fail to provide coverage for adequate
     treatment for infertility. According to the American Society for
     Reproductive Medicine, infertility affects approximately 6.1 million
     men and women in the U.S. -- about ten percent of the reproductive age
     population. Most infertility cases (85% to 90%) are treated with
     conventional medical therapies such as medication or surgery. While
     vital for some patients, in vitro fertilization and similar treatments


     account for less than 5% of infertility services, and only three
     hundredths of one percent (.003%) of U.S. health care costs.

     This bill would require health insurance policies to provide coverage
     for the diagnosis and treatment of infertility. For many years people
     have been confronted with the heartbreak that they were unable to
     conceive children for medical reasons. Medical science has advanced to
     a point where treatment is available to increase fertility. The desire
     to have children and be parents is one of the most fundamental aspects
     of being human. People should not be denied insurance coverage for
     medically appropriate treatment to fulfill this goal.

     Currently, twelve states have laws that require insurers to either
     cover or offer to cover some form of infertility treatment.

     PRIOR LEGISLATIVE HISTORY
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     This is new legislation.

     FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
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     None to the State.

     EFFECTIVE DATE:
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     January 1, after enactment.

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