HB104 (2005) Detail

Requiring insurance coverage for infertility treatments.


HB 104 – AS INTRODUCED

2005 SESSION

05-0027

01/09

HOUSE BILL 104

AN ACT requiring insurance coverage for infertility treatments.

SPONSORS: Rep. Crane, Hills 21; Rep. P. Smith, Rock 3; Rep Pilliod, Belk 5; Rep. Lasky, Hills 26

COMMITTEE: Commerce

ANALYSIS

This bill requires insurance coverage for infertility diagnosis and treatment up to the birth of a child.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

05-0027

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Five

AN ACT requiring insurance coverage for infertility treatments.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 415 by inserting after section 6-k the following new section:

415:6-l Coverage for Infertility Treatments.

I. Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. Such treatment shall continue up to the birth of a child. For purposes of this section “infertility” means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:

(a) Intrauterine insemination.

(b) In vitro fertilization (IVF).

(c) Frozen embryo transfer.

(d) Gamete intrafallopian transfer (GIFT).

(e) Zygote intrafallopian transfer (ZIFT).

(f) Intracytoplasmic sperm injection (ICSI).

(g) Seven completed egg retrievals per lifetime.

II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:

(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.

(b) The patient has not reached the maximum number of allowed egg retrievals.

III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.

(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.

(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.

(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).

2 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 415 by inserting after section 18-p the following new section:

415:18-q Coverage for Infertility Treatments.

I. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. Such treatment shall continue up to the birth of a child. For purposes of this section “infertility” means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:

(a) Intrauterine insemination.

(b) In vitro fertilization (IVF).

(c) Frozen embryo transfer.

(d) Gamete intrafallopian transfer (GIFT).

(e) Zygote intrafallopian transfer (ZIFT).

(f) Intracytoplasmic sperm injection (ICSI).

(g) Seven completed egg retrievals per lifetime.

II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:

(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.

(b) The patient has not reached the maximum number of allowed egg retrievals.

III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.

(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.

(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.

(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).

3 New Section; Coverage for Infertility Diagnosis and Treatment. Amend RSA 420-A by inserting after section 17-e the following new section:

420-A:17-f Coverage for Infertility Treatments.

I. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual, group, or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. Such treatment shall continue up to the birth of a child. For purposes of this section “infertility” means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:

(a) Intrauterine insemination.

(b) In vitro fertilization (IVF).

(c) Frozen embryo transfer.

(d) Gamete intrafallopian transfer (GIFT).

(e) Zygote intrafallopian transfer (ZIFT).

(f) Intracytoplasmic sperm injection (ICSI).

(g) Seven completed egg retrievals per lifetime.

II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:

(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.

(b) The patient has not reached the maximum number of allowed egg retrievals.

III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.

(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.

(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.

(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).

4 New Section; Coverage for Infertility Treatments. Amend RSA 420-B by inserting after section 8-j the following new section:

420-B:8-jj Coverage for Infertility Diagnosis and Treatment.

I. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual, group, or blanket health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diagnosis and treatment of infertility, including but not limited to diagnostic tests, procedures, and medications. Such treatment shall continue up to the birth of a child. For purposes of this section “infertility” means the presence of a demonstrated condition recognized by a licensed physician and/or surgeon as a cause of infertility; or the inability to conceive a pregnancy or carry a pregnancy to term after a year or more of unprotected intercourse. Coverage shall include, but not be limited to:

(a) Intrauterine insemination.

(b) In vitro fertilization (IVF).

(c) Frozen embryo transfer.

(d) Gamete intrafallopian transfer (GIFT).

(e) Zygote intrafallopian transfer (ZIFT).

(f) Intracytoplasmic sperm injection (ICSI).

(g) Seven completed egg retrievals per lifetime.

II. Coverage for the treatments in subparagraphs I(b), (d), (e), and (f) shall only be required if:

(a) The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy to term.

(b) The patient has not reached the maximum number of allowed egg retrievals.

III.(a) The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided.

(b) The benefits included in this section shall be offered by providers and facilities that conform to standards set forth by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists or other nationally recognized professional or government organizations. All guidelines and recommendations shall be based on scientific recommendations that have appeared in nationally recognized scientific journals.

(c) Nothing in this section shall limit the ability of an insurance carrier to select providers of these services provided that the requirements of subparagraph III(b) are met.

(d) The benefits included in this section shall be limited to those which have gained widespread acceptance in the United States and have been approved by those entities referred to in subparagraph III(b).

5 Effective Date. This act shall take effect 60 days after its passage.

LBAO

05-0027

1/31/05

HB 104 FISCAL NOTE

AN ACT requiring insurance coverage for infertility treatments.

FISCAL IMPACT:

      The Insurance Department has determined this bill may increase state general fund revenue by an indeterminable amount in FY 2006 and each year thereafter. The NH Association of Counties has determined this bill may increase county expenditures by an indeterminable amount in FY 2006 and each year thereafter. The NH Municipal Association has determined this bill may increase local expenditures by an indeterminable amount in FY 2006 and each year thereafter. There will be no fiscal impact on state expenditures and county or local revenue.

METHODOLOGY:

      The Insurance Department states this bill mandates insurance coverage for infertility treatments and that to the extent that state, county and local government provide health benefits to their employees through self-insured programs this mandate would not apply. However, if state, county or local governments provide health benefits to their employees through fully insured products, the cost of these programs will increase. Currently, health benefits for state employees are provided through a self-insured program, therefore, there would be no fiscal impact on state expenditures. The Department states it does not have sufficient information to estimate the impact this bill will have on insurance premiums, however, the Department indicated that increased insurance premium prices resulting from this bill will produce an increase in insurance premium tax revenue.

      The Association of Counties stated that to the extent a county provides health benefits to its employees through fully insured program this bill would increase premium costs, and therefore, increase county expenditures for health insurance by an indeterminable amount in FY 2006 and each year thereafter.

    The Municipal Association stated that to the extent a municipality provides health benefits to its employees through fully insured program this bill would increase premium costs, and therefore, increase local expenditures for health insurance by an indeterminable amount in FY 2006 and each year thereafter.

Links

HB104 at GenCourtMobile

Action Dates

Date Body Type

Bill Text Revisions

HB104 Revision: 8601 Date: Jan. 21, 2010, midnight

Docket