Revision: Jan. 5, 2024, 9:22 a.m.
SB 558-FN - AS INTRODUCED
2024 SESSION
24-3108
12/08
SENATE BILL 558-FN
SPONSORS: Sen. Perkins Kwoka, Dist 21; Sen. Whitley, Dist 15; Sen. Fenton, Dist 10; Sen. Watters, Dist 4; Sen. Rosenwald, Dist 13; Sen. Soucy, Dist 18; Sen. D'Allesandro, Dist 20; Sen. Altschiller, Dist 24; Rep. Grote, Rock. 24; Rep. Simpson, Rock. 33
COMMITTEE: Health and Human Services
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ANALYSIS
This bill provides insurance coverage for infertility treatments, protection from discrimination during IVF treatments, parental leave, and adoption.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
24-3108
12/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Short Title. This act shall be known as "The Modern Economy Act."
2 Access to Fertility Care; Definitions. Amend RSA 417-G:1, III-V to read as follows:
III. "Fertility treatment" means health care services or products provided with the intent to achieve a pregnancy for a patient with infertility that results in a live birth with healthy outcomes.
IV. "Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.
V. "Infertility" means a disease, condition or status [caused by an illness, injury, underlying disease, or condition.] where an individual's ability to become pregnant or to carry a pregnancy to live birth is impaired, or where an individual's ability to cause pregnancy and live birth in the individual's partner is impaired.
3 Access to Fertility Treatment. Amend RSA 417-G:2, II to read as follows:
II. Each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance coverage for medically necessary fertility treatment for infertility as defined in RSA 417-G:1. Enrollees shall be provided coverage for evaluations, laboratory assessments, medications, and treatments associated with the procurement of donor eggs, sperm, and embryos.
4 Unlawful Discrimination; Fertility Treatment. Amend RSA 354-A:7, VI to read as follows:
VI.(a) For the purposes of this chapter, the word "sex" includes pregnancy and medical conditions which cause or result from pregnancy or are otherwise related to pregnancy, including but not limited to fertility treatment as defined in RSA 417-G:1 or pregnancy loss or related bereavement time.
(b) An employer shall permit [a female] an employee to take leave of absence and attend appointments for the period of temporary physical disability resulting from pregnancy, childbirth or related medical conditions including but limited to well-being checkups, in-vitro fertilization follow up and postpartum care. When the employee is physically able to return to work, [her] that employee's original job or a comparable position shall be made available to [her] them by the employer unless business necessity makes this impossible or unreasonable.
5 Protective Legislation; Parental Leave. Amend RSA 275:43, V to read as follows:
V.(a) Vacation pay, severance pay, personal days, holiday pay, sick pay, and payment of employee expenses, when such benefits are a matter of employment practice or policy, or both, shall be considered wages pursuant to RSA 275:42, III, when due. The employer shall not have a policy or practice of requiring the use of any accrued paid time off as a condition of parental leave.
(b) An employer may limit the leave provided under this subdivision if the employee's leave creates an undue hardship to the employer's business. For this section, "undue hardship" shall mean any action that requires significant difficulty or expense when considered in relation to factors such as the size of the business, its financial resources and the nature and structure of its operation.
6 Effective Date. This act shall take effect 60 days after its passage.
24-3108
Revised 1/5/24
SB 558-FN- FISCAL NOTE
AS INTRODUCED
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Revenue Fund(s) | General Fund Insurance Premium Tax | |||||
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Funding Source(s) | General Fund Various Government Funds | |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• Does this bill provide sufficient funding to cover estimated expenditures? [X] No • Does this bill authorize new positions to implement this bill? [X] No | ||||||
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Estimated Political Subdivision Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
County Revenue | $0 | $0 | $0 | $0 | ||
County Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Local Revenue | $0 | $0 | $0 | $0 | ||
Local Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
METHODOLOGY:
The Insurance Department indicates this bill would amend the definition of infertility under RSA 417-G:1, VI (a) to replace “caused by an illness, injury, underlying disease, or condition” with “condition or status.” The Department interprets this amendment as removing medical necessity as it removes the language tying the definition to a medical condition. The new definition would have a more expansive meaning and would include individuals whose ability to become pregnant is impaired for nonmedical reasons. A recent mandate study conducted on behalf of the Department estimated that removing medical necessity from RSA 417-G could result in an increase of $9.50 to $100.30 in the per member per month premium in the large group market.
The bill would also amend RSA 275:43 to prohibit the practice of requiring the use of accrued paid time off as a condition of parental leave. Department regulations pertaining to Family and Medical Leave Wage Replacement coverage permit policies to require use of paid time off prior to receiving benefits. The practice is also incorporated and permitted in The New Hampshire Paid Family and Medical Leave program. The Department states prohibition of the practice would have a potential fiscal impact on that program and the cost of a premiums in insurance products.
The Department indicates insurers may respond with increased premium rates to reflect higher costs. Policyholders may respond by paying increased premiums or forgoing insurance if premiums are too high. This may have an impact on state premium tax revenue and state, county and local employers expenditures for insurance coverage.
The Department of Administrative Services states this bill would add in-vitro fertilization to the definition of "fertility treatments" and allow an employee to attend well-being appointments, in vitro fertilization follow up and postpartum care while providing the employee job protection during their absence. The employer could not require the employee to use accrued leave time during this absence. The Department assumes the bill would apply to all employers in the State, including the State as an employer. It is further assumed that if a person, employed by the State, were to take leave and not be required to use their accrued leave, the employee would be placed on an "unpaid leave" status. The length in time in which the person could be placed on "unpaid leave" is indeterminable. The Department indicates the fiscal impact to the State is indeterminable because there is no way to project how many employees will seek fertility treatment that would be covered under the proposed legislation or how long they may be out on unpaid leave. The Department assumes there would be indeterminable productivity costs associated with such employees not being present for work.
The New Hampshire Municipal Association states it is unclear if the modifications made to the definitions in RSA 417-G:1, III-V, would result in an increase to insurance premium amounts paid by municipal employers. Many municipalities may have an established personnel policy, contract or collective bargaining agreement that would already limit or prohibit the use of accrued paid time off for parental leave or adoption. It is unclear how many municipalities would be effected by this bill, what the cost would be to those impacted, and if employers would qualify for an “undue hardship” under proposed RSA 275:43,V (b),in which case, there would be no fiscal impact.
The New Hampshire Association of Counties indicates the majority of counties already offer a version of these benefits. The Association states there would be a cost to the counties as the time off would create a hardship in most departments. The Association is unable to determine how many individuals may take advantage of this leave and is not able to calculate the associated costs.
AGENCIES CONTACTED:
Departments of Insurance and Administrative Services, New Hampshire Municipal Association and New Hampshire Association of Counties