S 2619 NY

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Bill No.: Summary Actions Committee&nbspVotes Floor&nbspVotes Memo Text LFIN Chamber&nbspVideo/Transcript S02619 Summary: BILL NO S02619A &nbsp SAME AS SAME AS A07891-A

&nbsp SPONSOR SCARCELLA-SPANTON &nbsp COSPNSR ADDABBO &nbsp MLTSPNSR &nbsp Amd §§3221, 4303 & 3216, Ins L &nbsp Removes restrictions of three-cycle coverage for in vitro fertilization; mandates individual insurance coverage of in vitro.

Go to top S02619 Text:

STATE OF NEW YORK ________________________________________________________________________

2619--A

2025-2026 Regular Sessions

IN SENATE

January 21, 2025 ___________

Introduced by Sens. SCARCELLA-SPANTON, ADDABBO -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law, in relation to expanded coverage of in vitro fertilization

The People of the State of New York, represented in Senate and Assem- bly, do enact as follows:

1 Section 1. Item (vii) of subparagraph (C) of paragraph 6 of subsection 2 (k) of section 3221 of the insurance law, as amended by section 1 of 3 part L of chapter 57 of the laws of 2019, is amended to read as follows: 4 (vii) Every large group policy delivered or issued for delivery in 5 this state that provides medical, major medical or similar comprehen- 6 sive-type coverage shall provide coverage for [ three cycles of in-vitro ] 7 in vitro fertilization used in the treatment of infertility. Coverage 8 may be subject to annual deductibles and coinsurance, including copay- 9 ments, as may be deemed appropriate by the superintendent and as are 10 consistent with those established for other benefits within a given 11 policy. [ For purposes of this item, a "cycle" is defined as either all 12 treatment that starts when: preparatory medications are administered for 13 ovarian stimulation for oocyte retrieval with the intent of undergoing 14 in-vitro fertilization using a fresh embryo transfer; or medications are 15 administered for endometrial preparation with the intent of undergoing 16 in-vitro fertilization using a frozen embryo transfer. ] 17 § 2. Subparagraph (G) of paragraph 3 of subsection (s) of section 4303 18 of the insurance law, as amended by section 2 of part L of chapter 57 of 19 the laws of 2019, is amended to read as follows: 20 (G) Every large group contract that provides medical, major medical or 21 similar comprehensive-type coverage shall provide coverage for [ three 22 cycles of in-vitro ] in vitro fertilization used in the treatment of

EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06387-03-6

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1 infertility. Coverage may be subject to annual deductibles and coinsu- 2 rance, including copayments, as may be deemed appropriate by the super- 3 intendent and as are consistent with those established for other bene- 4 fits within a given contract. [ For purposes of this subparagraph, a 5 "cycle" is defined as either all treatment that starts when: preparatory 6 medications are administered for ovarian stimulation for oocyte 7 retrieval with the intent of undergoing in-vitro fertilization using a 8 fresh embryo transfer; or medications are administered for endometrial 9 preparation with the intent of undergoing in-vitro fertilization using a 10 frozen embryo transfer. ] 11 § 3. Paragraph 13 of subsection (i) of section 3216 of the insurance 12 law, as added by chapter 897 of the laws of 1990 and renumbered by chap- 13 ter 131 of the laws of 1992 and subparagraph (C) as added by section 3 14 of part L of chapter 57 of the laws of 2019, is amended to read as 15 follows: 16 (13) (A) Every policy which provides coverage for hospital care shall 17 not exclude coverage for hospital care for diagnosis and treatment of 18 correctable medical conditions otherwise covered by the policy solely 19 because the medical condition results in infertility[ . ] ; provided, 20 however that: 21 (i) subject to the provisions of subparagraph (C) of this paragraph, 22 in no case shall such coverage exclude surgical or medical procedures 23 provided as part of such hospital care which would correct malformation, 24 disease or dysfunction resulting in infertility; and 25 (ii) provided, further however, that subject to the provisions of 26 subparagraph (C) of this paragraph, in no case shall such coverage 27 exclude diagnostic tests and procedures provided as part of such hospi- 28 tal care that are necessary to determine infertility or that are neces- 29 sary in connection with any surgical or medical treatments or 30 prescription drug coverage provided pursuant to this paragraph, includ- 31 ing such diagnostic tests and procedures as hysterosalpingogram, hyster- 32 oscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital 33 tests, testis biopsy, semen analysis, blood tests and ultrasound; and 34 (iii) provided, further however, every such policy which provides 35 coverage for prescription drugs shall include, within such coverage, 36 coverage for prescription drugs approved by the federal Food and Drug 37 Administration for use in the diagnosis and treatment of infertility in 38 accordance with subparagraph (C) of this paragraph. 39 (B) Every policy which provides coverage for surgical and medical care 40 shall not exclude coverage for surgical and medical care for diagnosis 41 and treatment of correctable medical conditions otherwise covered by the 42 policy solely because the medical condition results in infertility[ . ] ; 43 provided, however that: 44 (i) subject to the provisions of subparagraph (C) of this paragraph, 45 in no case shall such coverage exclude surgical or medical procedures 46 which would correct malformation, disease or dysfunction resulting in 47 infertility; and 48 (ii) provided, further however, that subject to the provisions of 49 subparagraph (C) of this paragraph, in no case shall such coverage 50 exclude diagnostic tests and procedures that are necessary to determine 51 infertility or that are necessary in connection with any surgical or 52 medical treatments or prescription drug coverage provided pursuant to 53 this paragraph, including such diagnostic tests and procedures as 54 hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy, 55 sono-hysterogram, post coital tests, testis biopsy, semen analysis, 56 blood tests and ultrasound; and

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1 (iii) provided, further however, every such policy which provides 2 coverage for prescription drugs shall include, within such coverage, 3 coverage for prescription drugs approved by the federal Food and Drug 4 Administration for use in the diagnosis and treatment of infertility in 5 accordance with subparagraph (C) of this paragraph. 6 (C) [ Every policy that provides medical, major medical or similar 7 comprehensive-type coverage shall provide coverage for ] Coverage of 8 diagnostic and treatment procedures, including prescription drugs, used 9 in the diagnosis and treatment of infertility as required by subpara- 10 graphs (A) and (B) of this paragraph shall be provided in accordance 11 with the provisions of this subparagraph. 12 (i) Diagnosis and treatment of infertility shall be prescribed as part 13 of a physician's overall plan of care and consistent with the guidelines 14 for coverage as referenced in this subparagraph. 15 (ii) Coverage may be subject to co-payments, coinsurance and deduct- 16 ibles as may be deemed appropriate by the superintendent and as are 17 consistent with those established for other benefits within a given 18 policy. 19 (iii) Except as provided in items (vi) and (vii) of this subparagraph, 20 coverage shall not be required to include the diagnosis and treatment of 21 infertility in connection with: (I) in vitro fertilization, gamete 22 intrafallopian tube transfers or zygote intrafallopian tube transfers; 23 (II) the reversal of elective sterilizations; (III) sex change proce- 24 dures; (IV) cloning; or (V) medical or surgical services or procedures 25 that are deemed to be experimental in accordance with clinical guide- 26 lines referenced in item (iv) of this subparagraph. 27 (iv) The superintendent, in consultation with the commissioner of 28 health, shall promulgate regulations which shall stipulate the guide- 29 lines and standards which shall be used in carrying out the provisions 30 of this subparagraph, which shall include: 31 (I) The identification of experimental procedures and treatments not 32 covered for the diagnosis and treatment of infertility determined in 33 accordance with the standards and guidelines established and adopted by 34 the American College of Obstetricians and Gynecologists and the American 35 Society for Reproductive Medicine; 36 (II) The identification of the required training, experience and other 37 standards for health care providers for the provision of procedures and 38 treatments for the diagnosis and treatment of infertility determined in 39 accordance with the standards and guidelines established and adopted by 40 the American College of Obstetricians and Gynecologists and the American 41 Society for Reproductive Medicine; and 42 (III) The determination of appropriate medical candidates by the 43 treating physician in accordance with the standards and guidelines 44 established and adopted by the American College of Obstetricians and 45 Gynecologists and/or the American Society for Reproductive Medicine. 46 (v) Coverage shall also include standard fertility preservation 47 services when a medical treatment may directly or indirectly cause 48 iatrogenic infertility to an insured. Coverage may be subject to annual 49 deductibles and coinsurance, including copayments, as may be deemed 50 appropriate by the superintendent and as are consistent with those 51 established for other benefits within a given policy. 52 (vi) Every policy which provides coverage for hospital care shall 53 provide coverage for in vitro fertilization used in the treatment of 54 infertility. Coverage may be subject to annual deductibles and coinsu- 55 rance, including copayments, as may be deemed appropriate by the super-

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1 intendent and as are consistent with those established for other bene- 2 fits within a given policy. 3 (vii) (I) For the purposes of this paragraph, "infertility" means a 4 disease or condition characterized by the incapacity to impregnate 5 another person or to conceive, defined by the failure to establish a 6 clinical pregnancy after twelve months of regular, unprotected sexual 7 intercourse or therapeutic donor insemination, or after six months of 8 regular, unprotected sexual intercourse or therapeutic donor insemina- 9 tion for a female thirty-five years of age or older. Earlier evaluation 10 and treatment may be warranted based on an individual's medical history 11 or physical findings. 12 [ (i) ] (II) For purposes of this [ subparagraph ] paragraph , "iatrogenic 13 infertility" means an impairment of fertility by surgery, radiation, 14 chemotherapy or other medical treatment affecting reproductive organs or 15 processes. 16 [ (ii) ] (viii) No insurer providing coverage under this paragraph shall 17 discriminate based on an insured's expected length of life, present or 18 predicted disability, degree of medical dependency, perceived quality of 19 life, or other health conditions, nor based on personal characteristics, 20 including age, sex, sexual orientation, marital status or gender identi- 21 ty. 22 (D) Every policy that provides coverage for prescription fertility 23 drugs and requires or permits prescription drugs to be purchased through 24 a network participating mail order or other non-retail pharmacy shall 25 provide the same coverage for prescription fertility drugs when such 26 drugs are purchased from a network participating non-mail order retail 27 pharmacy provided that the network participating non-mail order retail 28 pharmacy agrees in advance through a contractual network agreement, to 29 the same reimbursement amount, as well as the same applicable terms and 30 conditions, that the insurer has established for a network participating 31 mail order or other non-retail pharmacy. In such case, the policy shall 32 not impose any fee, co-payment, co-insurance, deductible or other condi- 33 tion on any covered person who elects to purchase prescription fertility 34 drugs through a network participating non-mail order retail pharmacy 35 that it does not impose on any covered person who purchases prescription 36 fertility drugs through a network participating mail order or other 37 non-retail pharmacy; provided, however, that the provisions of this 38 section shall not supersede the terms of a collective bargaining agree- 39 ment or apply to a policy that is the result of a collective bargaining 40 agreement between an employer and a recognized or certified employee 41 organization. 42 § 4. This act shall take effect on the first of January next succeed- 43 ing the date on which it shall have become a law and shall apply to 44 policies and contracts issued, renewed, modified, altered or amended on 45 or after such date.

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