S T A T E O F N E W Y O R K ________________________________________________________________________ 7303 1999-2000 Regular Sessions I N A S S E M B L Y March 29, 1999 ___________ Introduced by M. of A. SILVER, DiNAPOLI, SIDIKMAN, COLMAN, PHEFFER, CYMBROWITZ, WEINSTEIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to health insurance coverage for diagnostic testing and treatment for infertility THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 13 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 897 of the laws of 1990, and as 3 renumbered by chapter 131 of the laws of 1992, is amended to read as 4 follows: 5 (13) (A) Every policy which provides coverage for hospital care shall 6 [not exclude] INCLUDE coverage for hospital care for diagnosis and 7 treatment of [correctable] medical conditions [otherwise covered by the 8 policy solely because the medical condition results] WHICH RESULT in 9 infertility. 10 (B) Every policy which provides coverage for surgical and medical care 11 shall [not exclude] INCLUDE coverage for surgical and medical care for 12 diagnosis and treatment of [correctable] medical conditions [otherwise 13 covered by the policy solely because the medical condition results] 14 WHICH RESULT in infertility. 15 § 2. Paragraph 6 of subsection (k) of section 3221 of the insurance 16 law, as added by chapter 897 of the laws of 1990, is amended to read as 17 follows: 18 (6) (A) Every group policy issued or delivered in this state which 19 provides coverage for hospital care shall [not exclude] INCLUDE coverage 20 for hospital care for diagnosis and treatment of [correctable] medical 21 conditions [otherwise covered by the policy solely because the medical 22 condition results] WHICH RESULT in infertility. 23 (B) Every group policy issued or delivered in this state which 24 provides coverage for surgical and medical care shall [not exclude] PAGE-2 1 INCLUDE coverage for surgical and medical care for diagnosis and treat- 2 ment of [correctable] medical conditions [otherwise covered by the poli- 3 cy solely because the medical condition results] WHICH RESULT in infer- 4 tility. 5 § 3. Subsection (s) of section 4303 of the insurance law, as added by 6 chapter 897 of the laws of 1990 and relettered by chapter 131 of the 7 laws of 1992, is amended to read as follows: 8 (s) (1) A hospital service corporation or health service corporation 9 which provides coverage for hospital care shall [not exclude] INCLUDE 10 coverage for hospital care for diagnosis and treatment of [correctable] 11 medical conditions [otherwise covered by the policy solely because the 12 medical condition results] WHICH RESULT in infertility. 13 (2) A medical expense indemnity or health service corporation which 14 provides coverage for surgical and medical care shall [not exclude] 15 INCLUDE coverage for surgical and medical care for diagnosis and treat- 16 ment of [correctable] medical conditions [otherwise covered by the poli- 17 cy solely because the medical condition results] WHICH RESULT in infer- 18 tility. 19 § 4. Subsection (i) of section 3216 of the insurance law is amended by 20 adding a new paragraph 23 to read as follows: 21 (23) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE 22 WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN 23 SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR 24 MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE 25 FOR THE DIAGNOSIS AND TREATMENT OF INFERTILITY, INCLUDING, BUT NOT 26 LIMITED TO, DRUG THERAPY, ARTIFICIAL INSEMINATION, IN VITRO FERTILIZA- 27 TION, INTRACYTOPLASMIC SPERM INJECTION, GAMETE DONATION, EMBRYO 28 DONATION, ASSISTED HATCHING, UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER, 29 GAMETE INTRAFALLOPIAN TUBE TRANSFER, ZYGOTE INTRAFALLOPIAN TUBE TRANS- 30 FER, LOW TUBAL OVUM TRANSFER AND ANY OTHER MEDICALLY INDICATED SERVICE 31 OR PROCEDURE THAT IS USED TO TREAT INFERTILITY OR INDUCE PREGNANCY. 32 (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 33 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 34 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 35 (C) COVERAGE FOR PROCEDURES FOR IN VITRO FERTILIZATION, INTRACYTO- 36 PLASMIC SPERM INJECTION, ASSISTED HATCHING, GAMETE DONATION, EMBRYO 37 DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE 38 INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF: 39 (I) THE COVERED INDIVIDUAL HAS BEEN UNABLE TO ATTAIN OR SUSTAIN A 40 SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI- 41 ATE INFERTILITY TREATMENTS FOR WHICH COVERAGE IS AVAILABLE UNDER THE 42 POLICY, PLAN OR CONTRACT; 43 (II) THE COVERED INDIVIDUAL HAS NOT UNDERGONE FOUR COMPLETED EMBRYO 44 TRANSFERS, EXCEPT THAT IF A LIVE BIRTH FOLLOWS A COMPLETED EMBRYO TRANS- 45 FER, THEN TWO MORE COMPLETED EMBRYO TRANSFERS SHALL BE COVERED; AND 46 (III) THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM 47 TO THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR 48 ASSISTED REPRODUCTIVE TECHNOLOGY OR TO THE AMERICAN SOCIETY FOR REPRO- 49 DUCTIVE MEDICINE MINIMAL STANDARDS FOR ASSISTED REPRODUCTIVE TECHNOLOGY. 50 (D) FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEANS THE INABILITY TO 51 CONCEIVE AFTER ONE YEAR OF UNPROTECTED SEXUAL INTERCOURSE OR THE INABIL- 52 ITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A DEMONSTRATED 53 CONDITION RECOGNIZED BY A LICENSED PHYSICIAN AS A CAUSE OF THE INABILITY 54 TO CONCEIVE OR SUSTAIN A PREGNANCY TO A LIVE BIRTH OR THE PRESENCE OF A 55 DEMONSTRATED CONDITION IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A PAGE-3 1 PHYSICIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A LIVE 2 BIRTH. 3 (E) FOR PURPOSES OF THIS SECTION, "ASSISTED REPRODUCTIVE TECHNOLOGY" 4 MEANS ALL TREATMENT OR PROCEDURES THAT INVOLVE THE HANDLING OF HUMAN 5 EGGS AND SPERM FOR THE PURPOSE OF ESTABLISHING A PREGNANCY. 6 § 5. Subsection (k) of section 3221 of the insurance law is amended by 7 adding a new paragraph 13 to read as follows: 8 (13) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE 9 WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN 10 SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR 11 MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE 12 FOR THE DIAGNOSIS AND TREATMENT OF INFERTILITY, INCLUDING, BUT NOT 13 LIMITED TO, DRUG THERAPY, ARTIFICIAL INSEMINATION, IN VITRO FERTILIZA- 14 TION, INTRACYTOPLASMIC SPERM INJECTION, GAMETE DONATION, EMBRYO 15 DONATION, ASSISTED HATCHING, UTERINE EMBRYO LAVAGE, EMBRYO TRANSFER, 16 GAMETE INTRAFALLOPIAN TUBE TRANSFER, ZYGOTE INTRAFALLOPIAN TUBE TRANS- 17 FER, LOW TUBAL OVUM TRANSFER AND ANY OTHER MEDICALLY INDICATED SERVICE 18 OR PROCEDURE THAT IS USED TO TREAT INFERTILITY OR INDUCE PREGNANCY. 19 (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 20 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 21 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 22 (C) COVERAGE FOR PROCEDURES FOR IN VITRO FERTILIZATION, INTRACYTO- 23 PLASMIC SPERM INJECTION, ASSISTED HATCHING, GAMETE DONATION, EMBRYO 24 DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE 25 INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF: 26 (I) THE COVERED INDIVIDUAL HAS BEEN UNABLE TO ATTAIN OR SUSTAIN A 27 SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI- 28 ATE INFERTILITY TREATMENTS FOR WHICH COVERAGE IS AVAILABLE UNDER THE 29 POLICY, PLAN OR CONTRACT. 30 (II) THE COVERED INDIVIDUAL HAS NOT UNDERGONE FOUR COMPLETED EMBRYO 31 TRANSFERS, EXCEPT THAT IF A LIVE BIRTH FOLLOWS A COMPLETED EMBRYO TRANS- 32 FER, THEN TWO MORE COMPLETED EMBRYO TRANSFERS SHALL BE COVERED; AND 33 (III) THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM 34 TO THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR 35 ASSISTED REPRODUCTIVE TECHNOLOGY OR TO THE AMERICAN SOCIETY FOR REPRO- 36 DUCTIVE MEDICINE MINIMAL STANDARDS FOR ASSISTED REPRODUCTIVE TECHNOLOGY. 37 (D) FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEANS THE INABILITY TO 38 CONCEIVE AFTER ONE YEAR OF UNPROTECTED SEXUAL INTERCOURSE OR THE INABIL- 39 ITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A DEMONSTRATED 40 CONDITION RECOGNIZED BY A LICENSED PHYSICIAN AS A CAUSE OF THE INABILITY 41 TO CONCEIVE OR SUSTAIN A PREGNANCY TO A LIVE BIRTH OR THE PRESENCE OF A 42 DEMONSTRATED CONDITION IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A 43 PHYSICIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A LIVE 44 BIRTH. 45 (E) FOR PURPOSES OF THIS SECTION, "ASSISTED REPRODUCTIVE TECHNOLOGY" 46 MEANS ALL TREATMENT OR PROCEDURES THAT INVOLVE THE HANDLING OF HUMAN 47 EGGS AND SPERM FOR THE PURPOSE OF ESTABLISHING A PREGNANCY. 48 § 6. Section 4303 of the insurance law is amended by adding a new 49 subsection (aa) to read as follows: 50 (AA) (1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO- 51 RATION, HOSPITAL SERVICE CORPORATION OR HEALTH SERVICE CORPORATION 52 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MEDICAL 53 COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S 54 OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPRE- 55 HENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE FOR THE DIAGNOSIS AND 56 TREATMENT OF INFERTILITY, INCLUDING, BUT NOT LIMITED TO, DRUG THERAPY, PAGE-4 1 ARTIFICIAL INSEMINATION, IN VITRO FERTILIZATION, INTRACYTOPLASMIC SPERM 2 INJECTION, GAMETE DONATION, EMBRYO DONATION, ASSISTED HATCHING, UTERINE 3 EMBRYO LAVAGE, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER, 4 ZYGOTE INTRAFALLOPIAN TUBE TRANSFER, LOW TUBAL OVUM TRANSFER AND ANY 5 OTHER MEDICALLY INDICATED SERVICE OR PROCEDURE THAT IS USED TO TREAT 6 INFERTILITY OR INDUCE PREGNANCY. 7 (2) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE 8 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT 9 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY. 10 (3) COVERAGE FOR PROCEDURES FOR IN VITRO FERTILIZATION, INTRACYTO- 11 PLASMIC SPERM INJECTION, ASSISTED HATCHING, GAMETE DONATION, EMBRYO 12 DONATION, EMBRYO TRANSFER, GAMETE INTRAFALLOPIAN TUBE TRANSFER OR ZYGOTE 13 INTRAFALLOPIAN TUBE TRANSFER SHALL BE REQUIRED ONLY IF: 14 (A) THE COVERED INDIVIDUAL HAS BEEN UNABLE TO ATTAIN OR SUSTAIN A 15 SUCCESSFUL PREGNANCY THROUGH REASONABLE, LESS COSTLY MEDICALLY APPROPRI- 16 ATE INFERTILITY TREATMENTS FOR WHICH COVERAGE IS AVAILABLE UNDER THE 17 POLICY, PLAN OR CONTRACT; 18 (B) THE COVERED INDIVIDUAL HAS NOT UNDERGONE FOUR COMPLETED EMBRYO 19 TRANSFERS, EXCEPT THAT IF A LIVE BIRTH FOLLOWS A COMPLETED EMBRYO TRANS- 20 FER, THEN TWO MORE COMPLETED EMBRYO TRANSFERS SHALL BE COVERED; AND 21 (C) THE PROCEDURES ARE PERFORMED AT MEDICAL FACILITIES THAT CONFORM TO 22 THE AMERICAN COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR ASSISTED 23 REPRODUCTIVE TECHNOLOGY OR TO THE AMERICAN SOCIETY FOR REPRODUCTIVE 24 MEDICINE MINIMAL STANDARDS FOR ASSISTED REPRODUCTIVE TECHNOLOGY. 25 (4) FOR PURPOSES OF THIS SECTION, "INFERTILITY" MEANS THE INABILITY TO 26 CONCEIVE AFTER ONE YEAR OF UNPROTECTED SEXUAL INTERCOURSE OR THE INABIL- 27 ITY TO SUSTAIN A SUCCESSFUL PREGNANCY OR THE PRESENCE OF A DEMONSTRATED 28 CONDITION RECOGNIZED BY A LICENSED PHYSICIAN AS A CAUSE OF THE INABILITY 29 TO CONCEIVE OR SUSTAIN A PREGNANCY TO A LIVE BIRTH OR THE PRESENCE OF A 30 DEMONSTRATED CONDITION IN THE MALE OR FEMALE PARTNER RECOGNIZED BY A 31 PHYSICIAN AS A CAUSE OF THE INABILITY TO CONCEIVE OR SUSTAIN A LIVE 32 BIRTH. 33 (5) FOR PURPOSES OF THIS SECTION, "ASSISTED REPRODUCTIVE TECHNOLOGY" 34 MEANS ALL TREATMENT OR PROCEDURES THAT INVOLVE THE HANDLING OF HUMAN 35 EGGS AND SPERM FOR THE PURPOSE OF ESTABLISHING A PREGNANCY. 36 § 7. This act shall take effect on the first day of January next 37 succeeding the date on which it shall have become a law and shall apply 38 to all policies issued, renewed, altered or modified on or after such 39 date. .