SECTION 1. Section 27-18-30 of the General Laws in Chapter 27-18 entitled "Accident and Sickness Insurance Policies" is hereby amended to read as follows: 27-18-30. Health insurance contracts — Infertility.
(a) Any health insurance contract, plan, or policy delivered or issued for delivery or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services. when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health insurance contract provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, the tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years; provided, that a subscriber copayment not to exceed twenty percent (20%) may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b) For purposes of this section, “infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(c) For the purposes of this section, the following terms shall have the following meanings:
(1) “Infertility” means:
(i) The presence of a condition recognized by a healthcare provider that impacts an individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. This condition includes infertility arising from a disability or medical treatments or conditions associated with a disability;
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iv) An individual’s inability to establish a pregnancy because the individual or the individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
(v) An individual’s increased risk, independently or with the individual’s partner, of transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
(vi) As defined by the American Society of Reproductive Medicine.
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard fertility-preservation services" means procedures, counseling, products, medications, genetic testing, and services intended to preserve fertility consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine or, the American Society of Clinical Oncology, or other reputable professional medical organizations, for an individual who has a medical or genetic condition, including conditions related to a disability or chronic illness, or who is expected to undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(g) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
(d) Coverage for the treatment of infertility under this section shall be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
(e) Coverage for the treatment of infertility under this section shall include, but shall not be limited to:
(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval;
(2) The medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party;
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate; and
(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including, but not limited to, preimplantation genetic testing.
(f) An insurer described in subsection (a) of this section shall not impose any of the following:
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis and treatment of infertility, including the prescription of fertility medications, different from those imposed on benefits for services not related to infertility;
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits;
(3) Limitations on coverage based solely on arbitrary factors, including number of attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements on, a class protected under § 23-17-19.1, than that provided to other insureds;
(4) Impose any limitations on coverage required under this section based on an individual's use of donor gametes, donor embryos or surrogacy;
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications; or
(6) Limitations under the policy based on anything other than the medical assessment of an individual’s licensed healthcare provider.
(g) An insurer described in subsection (a) of this section shall provide coverage under this section regardless of whether the insured foregoes a particular fertility treatment or procedure, if the insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any clinical guidelines used for a policy subject to the requirements of this section shall be based on current guidelines developed by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
SECTION 2. Section 27-19-23 of the General Laws in Chapter 27-19 entitled "Nonprofit Hospital Service Corporations" is hereby amended to read as follows: 27-19-23. Coverage for infertility.
(a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services. when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit hospital service corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
(25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b) For purposes of this section, “infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(c) For the purposes of this section, the following terms shall have the following meanings:
(1) “Infertility” means:
(i) The presence of a condition recognized by a healthcare provider that impacts an individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. This condition includes infertility arising from a disability or medical treatments or conditions associated with a disability;
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iv) An individual’s inability to establish a pregnancy because the individual or the individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
(v) An individual’s increased risk, independently or with the individual’s partner, of transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
(vi) As defined by the American Society of Reproductive Medicine.
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard fertility-preservation services" means procedures, counseling, products, medications, genetic testing, and services intended to preserve fertility consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations, for an individual who has a medical or genetic condition, including conditions related to a disability or chronic illness, or who is expected to undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
(d) Coverage for the treatment of infertility under this section shall be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
(e) Coverage for the treatment of infertility under this section shall include, but shall not be limited to:
(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval;
(2) The medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party;
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate; and
(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including, but not limited, to preimplantation genetic testing.
(f) An insurer described in subsection (a) of this section shall not impose any of the following:
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis and treatment of infertility, including the prescription of fertility medications, different from those imposed on benefits for services not related to infertility;
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits;
(3) Limitations on coverage based solely on arbitrary factors, including number of attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements on, a class protected under § 23-17-19.1, than that provided to other insureds;
(4) Impose any limitations on coverage required under this section based on an individual's use of donor gametes, donor embryos or surrogacy;
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications; or
(6) Limitations under the policy based on anything other than the medical assessment of an individual’s licensed healthcare provider.
(g) An insurer described in subsection (a) of this section shall provide coverage under this section regardless of whether the insured foregoes a particular fertility treatment or procedure, if the insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any clinical guidelines used for a policy subject to the requirements of this section shall be based on current guidelines developed by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
SECTION 3. Section 27-20-20 of the General Laws in Chapter 27-20 entitled "Nonprofit Medical Service Corporations" is hereby amended to read as follows: 27-20-20. Coverage for infertility.
(a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for the medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services. when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a nonprofit medical service corporation provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b) For purposes of this section, “infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(c) For the purposes of this section, the following terms shall have the following meanings:
(1) “Infertility” means:
(i) The presence of a condition recognized by a healthcare provider that impacts an individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. This condition includes infertility arising from a disability or medical treatments or conditions associated with a disability;
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iv) An individual’s inability to establish a pregnancy because the individual or the individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
(v) An individual’s increased risk, independently or with the individual’s partner, of transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
(vi) As defined by the American Society of Reproductive Medicine.
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard fertility-preservation services" means procedures, counseling, products, medications, genetic testing, and services intended to preserve fertility consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations, for an individual who has a medical or genetic condition, including conditions related to a disability or chronic illness, or who is expected to undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
(d) Coverage for the treatment of infertility under this section shall be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
(e) Coverage for the treatment of infertility under this section shall include, but shall not be limited to:
(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval;
(2) The medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party;
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate; and
(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including, but not limited to, preimplantation genetic testing.
(f) An insurer described in subsection (a) of this section shall not impose any of the following:
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis and treatment of infertility, including the prescription of fertility medications, different from those imposed on benefits for services not related to infertility;
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits;
(3) Limitations on coverage based solely on arbitrary factors, including number of attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements on, a class protected under § 23-17-19.1, than that provided to other insureds;
(4) Impose any limitations on coverage required under this section based on an individual's use of donor gametes, donor embryos or surrogacy;
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications; or
(6) Limitations under the policy based on anything other than the medical assessment of an individual’s licensed healthcare provider.
(g) An insurer described in subsection (a) of this section shall provide coverage under this section regardless of whether the insured foregoes a particular fertility treatment or procedure, if the insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any clinical guidelines used for a policy subject to the requirements of this section shall be based on current guidelines developed by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
SECTION 4. Section 27-41-33 of the General Laws in Chapter 27-41 entitled "Health Maintenance Organizations" is hereby amended to read as follows: 27-41-33. Coverage for infertility.
(a) Any health maintenance organization service contract plan or policy delivered, issued for delivery, or renewed in this state, except a contract providing supplemental coverage to Medicare or other governmental programs, that includes pregnancy-related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years and for standard fertility-preservation services. when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. To the extent that a health maintenance organization provides reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than infertility, those tests and procedures shall not be excluded from reimbursement when provided attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
(25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent (20%), may be required for those programs and/or procedures the sole purpose of which is the treatment of infertility.
(b) For purposes of this section, “infertility” means the condition of an otherwise healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
(b) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary, this section shall apply to blanket or group policies of insurance.
(c) For the purposes of this section, the following terms shall have the following meanings:
(1) “Infertility” means:
(i) The presence of a condition recognized by a healthcare provider that impacts an individual’s ability to establish a pregnancy or carry a pregnancy to live birth, based on an individual’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. This condition includes infertility arising from a disability or medical treatments or conditions associated with a disability;
(ii) An individual’s inability to establish a pregnancy or to carry a pregnancy to live birth after twelve (12) months of unprotected sexual intercourse when the individual and the individual’s partner have the necessary gametes to establish a pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iii) An individual's inability to establish a pregnancy after six (6) months of unprotected sexual intercourse or carry a pregnancy to live birth due to an individual's age when the individual and the individual’s partner have the necessary gametes to establish pregnancy. Pregnancy loss does not restart the twelve (12) month time period;
(iv) An individual’s inability to establish a pregnancy because the individual or the individual and the individual’s partner do not have the necessary gametes to establish a pregnancy;
(v) An individual’s increased risk, independently or with the individual’s partner, of transmitting a serious, inheritable genetic or chromosomal abnormality to a child; or
(vi) As defined by the American Society of Reproductive Medicine.
(c) For purposes of this section, “standard fertility-preservation services” (2) "Standard fertility-preservation services" means procedures, counseling, products, medications, genetic testing, and services intended to preserve fertility consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations, for an individual who has a medical or genetic condition, including conditions related to a disability or chronic illness, or who is expected to undergo treatment that has a possible side effect of or may directly or indirectly cause a risk of impairment of fertility, and includes, but is not limited to, the procurement, cryopreservation, and storage of gametes, embryos, and reproductive material.
(d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
(e) For purposes of this section, “may directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organizations.
(f) The health insurance contract may limit coverage to a lifetime cap of one hundred thousand dollars ($100,000).
(d) Coverage for the treatment of infertility under this section shall be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, ethnicity, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
(e) Coverage for the treatment of infertility under this section shall include, but shall not be limited to:
(1) At least four (4) complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval;
(2) The medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party;
(3) Coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate; and
(4) Procedures necessary to screen or diagnose a fertilized egg before transfer including, but not limited to, preimplantation genetic testing.
(f) An insurer described in subsection (a) of this section shall not impose any of the following:
(1) Deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis and treatment of infertility, including the prescription of fertility medications, different from those imposed on benefits for services not related to infertility;
(2) Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility nor use any prior diagnosis of or prior treatment of infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits;
(3) Limitations on coverage based solely on arbitrary factors, including number of attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements on, a class protected under § 23-17-19.1, than that provided to other insureds;
(4) Impose any limitations on coverage required under this section based on an individual's use of donor gametes, donor embryos or surrogacy;
(5) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications; or
(6) Limitations under the policy based on anything other than the medical assessment of an individual’s licensed healthcare provider.
(g) An insurer described in subsection (a) of this section shall provide coverage under this section regardless of whether the insured foregoes a particular fertility treatment or procedure, if the insured’s healthcare provider determines that the treatment or procedure is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
(h) This section does not interfere with the clinical judgment of a healthcare provider. Any clinical guidelines used for a policy subject to the requirements of this section shall be based on current guidelines developed by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
SECTION 5. This act shall take effect on January 1, 2027.
