HF 3591

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring health plans to provide coverage for certain infertility
treatments; proposing coding for new law in Minnesota Statutes, chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.81] COVERAGE FOR INFERTILITY.
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new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have
the meanings given.
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new text begin (a) "Commissioner" has the meaning given in section 62Q.01, subdivision 2.
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new text begin (b) "Experimental infertility procedure" means a procedure not yet recognized as
nonexperimental.
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new text begin (c) "Infertile or infertility" means a disease or condition that results in the abnormal
function of the reproductive system such that:
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new text begin (1) a person is unable to impregnate his or her partner;
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new text begin (2) a female under 35 years of age is unable to conceive after one year of unprotected
sexual intercourse;
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new text begin (3) a female 35 years of age and over is unable to conceive after six months of
unprotected sexual intercourse;
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new text begin (4) the male or female is medically sterile; or
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new text begin (5) the female is unable to carry a pregnancy to live birth.
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new text begin Infertility does not mean a person who has been voluntarily sterilized regardless of
whether the person has attempted to reverse the sterilization.
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new text begin (d) "Insured" means a subscriber, member, policyholder, certificate holder, or the
insured's covered spouse or other covered dependent.
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new text begin (e) "Insurer" means a health plan, health plan company, or managed care
organization as defined in section 62Q.01.
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new text begin (f) "Nonexperimental infertility procedure" means a procedure which is:
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new text begin (1) recognized as such by the American Society for Reproductive Medicine (ASRM)
or the American College of Obstetrics and Gynecology (ACOG); and
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new text begin (2) incorporated in this section by the commissioner.
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new text begin Subd. 2. new text end

new text begin Scope of coverage. new text end

new text begin Insurers shall provide benefits for required infertility
procedures, as specified in subdivision 3, which are furnished to an insured, covered
partner, or other covered dependent without regard to whether the person is infertile or
otherwise unable to have children due to social conditions or sexual orientation. Insurers
shall not be required to provide benefits for services furnished to a partner, or dependent if
the partner or dependent is not otherwise covered by the insurer, except as provided in
subdivision 3, clause (4).
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new text begin Subd. 3. new text end

new text begin Required infertility benefits. new text end

new text begin Subject to limitations as described in
subdivision 6, insurers shall provide benefits for all nonexperimental infertility procedures
including, but not limited to:
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new text begin (1) assisted hatching;
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new text begin (2) blastocyst culturing;
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new text begin (3) cryopreservation of eggs, sperm, or inseminated eggs for the period of one year;
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new text begin (4) egg retrieval;
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new text begin (5) gamete intrafallopian transfer (GIFT);
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new text begin (6) intracytoplasmic sperm injection (ICSI) for the treatment of male factor
infertility;
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new text begin (7) intrauterine insemination (IUI);
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new text begin (8) in vitro fertilization and fresh and frozen embryo transfer (IVF-ET);
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new text begin (9) low tubal ovum transfer;
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new text begin (10) medical costs of egg retrieval from a live donor where a live donor is used;
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new text begin (11) preimplantation genetic diagnosis to avoid transmission of familial dominant or
recessive gene diseases or structural chromosome defects like translocations or inversions;
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new text begin (12) sperm, egg, or inseminated egg procurement and processing, and banking
of sperm or inseminated eggs, to the extent such costs are not covered by the donor's
insurer, if any; and
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new text begin (13) zygote intrafallopian transfer (ZIFT).
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new text begin Subd. 4. new text end

new text begin Prescription drugs. new text end

new text begin Insurers shall not impose exclusions, limitations, or
other restrictions on coverage for infertility-related drugs that are different from those
imposed on any other prescription drugs.
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new text begin Subd. 5. new text end

new text begin Optional infertility benefits. new text end

new text begin No insurer shall be required to provide
benefits for:
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new text begin (1) any experimental infertility procedure, until the procedure becomes recognized
as nonexperimental and is recognized by ASRM or ACOG; or
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new text begin (2) reversal of voluntary sterilization.
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new text begin Subd. 6. new text end

new text begin Prohibited limitations on coverage. new text end

new text begin (a) An insurer shall not impose
deductibles, co-payments, coinsurance, benefit maximums, waiting periods, or any other
limitations on coverage for required infertility benefits which are different from those
imposed upon benefits for services not related to infertility.
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new text begin (b) An insurer shall not impose preexisting condition exclusions or preexisting
condition waiting periods on coverage for required infertility benefits. An insurer shall not
use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting,
or otherwise restricting the availability of coverage for required infertility benefits.
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new text begin Subd. 7. new text end

new text begin Permissible limitations on coverage. new text end

new text begin Insurers may establish reasonable
eligibility requirements based upon the insured's medical history and reasonable provider
contracting standards. Eligibility requirements based solely on arbitrary factors including,
but not limited to, number of attempts or dollar amounts shall be presumed invalid. These
requirements and standards shall be maintained in written form and shall be available to
any insured and the commissioner upon request. Standards or guidelines developed by
ASRM or ACOG shall serve as a basis for eligibility and contracting requirements.
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new text begin Subd. 8. new text end

new text begin Recognition of additional nonexperimental procedures. new text end

new text begin Any person
may petition the commissioner for the recognition of a procedure as nonexperimental.
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new text begin Subd. 9. new text end

new text begin Effective date. new text end

new text begin This section shall apply to any contract, policy, or plan
offering hospital, surgical, or medical expense coverage and which is issued or renewed,
within or outside the state of Minnesota, on or after August 1, 2008, and providing
coverage for any Minnesota resident. This section is necessary to afford full coverage to
those with a need for infertility benefits.
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new text begin Subd. 10. new text end

new text begin Severability. new text end

new text begin If any part of this section or the applicability thereof to any
person, entity, or circumstance is held invalid by a court, the remainder of this section
or the applicability of remaining provisions to other persons, entities, or circumstances
shall not be affected.
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