S 5545: Establishes "The Equity in Fertility Treatment Act"; relates to the definition of infertility and health insurance coverage for the treatment of infertility.

  
  STATE OF NEW YORK ________________________________________________________________________ 5545 2025-2026 Regular Sessions  IN SENATE February 24, 2025 ___________ Introduced by Sens. HOYLMAN-SIGAL, COONEY -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance AN ACT to amend the insurance law, in relation to the definition of infertility and health insurance coverage for in-vitro fertilization The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act shall be known and may be cited as "The Equity in 2 Fertility Treatment Act". 3 § 2. Items (v) and (vii) of subparagraph (C) of paragraph 6 of 4 subsection (k) of section 3221 of the insurance law, as amended by 5 section 1 of part L of chapter 57 of the laws of 2019, are amended to 6 read as follows: 7 (v)(I) For the purposes of this paragraph, "infertility" means a 8 disease or condition characterized by the incapacity to impregnate 9 another person or to conceive, defined by (a) the failure to establish a 10 clinical pregnancy after twelve months of regular, unprotected sexual 11 intercourse or therapeutic donor insemination, or after six months of 12 regular, unprotected sexual intercourse or therapeutic donor insemina- 13 tion for a female thirty-five years of age or older; (b) a person's 14 inability to reproduce either as a single individual or with their part- 15 ner without medical intervention; or (c) a licensed physician's or 16 osteopathic physician's findings based on a patient's medical, sexual, 17 or reproductive history, age, physical findings, or diagnostic testing. 18 Earlier evaluation and treatment may be warranted based on an individ- 19 ual's medical, sexual, or reproductive history [or], age, physical find- 20 ings, or diagnostic testing. 21 (II) For purposes of this paragraph, "iatrogenic infertility" means an 22 impairment of fertility by surgery, radiation, chemotherapy or other 23 medical treatment affecting reproductive organs or processes. 24 (vii) Every large group policy delivered or issued for delivery in 25 this state that provides medical, major medical or similar comprehen- 26 sive-type coverage shall provide coverage for three [cycles of] 27 completed oocyte retrievals and in-vitro fertilization [used in the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03493-01-5 
 S. 5545 2 1 treatment of infertility] with unlimited embryo transfers from fresh or 2 frozen oocytes or embryos from a covered retrieval, in accordance with 3 the guidelines of the American Society for Reproductive Medicine, using 4 single embryo transfer (SET) when recommended and medically appropriate 5 for the treatment of infertility. Coverage (I) shall not be denied based 6 on a covered individual's participation in fertility services provided 7 by or to a third party, and (II) may be subject to annual deductibles 8 and coinsurance, including copayments, as may be deemed appropriate by 9 the superintendent and as are consistent with those established for 10 other benefits within a given policy. [For purposes of this item, a 11 "cycle" is defined as either all treatment that starts when: preparatory 12 medications are administered for ovarian stimulation for oocyte 13 retrieval with the intent of undergoing in-vitro fertilization using a 14 fresh embryo transfer; or medications are administered for endometrial 15 preparation with the intent of undergoing in-vitro fertilization using a 16 frozen embryo transfer.] 17 § 3. Subparagraphs (E) and (G) of paragraph 3 of subsection (s) of 18 section 4303 of the insurance law, as amended by section 2 of part L of 19 chapter 57 of the laws of 2019, are amended to read as follows: 20 (E)(i) For the purposes of this subsection, "infertility" means a 21 disease or condition characterized by the incapacity to impregnate 22 another person or to conceive, defined by (a) the failure to establish a 23 clinical pregnancy after twelve months of regular, unprotected sexual 24 intercourse or therapeutic donor insemination, or after six months of 25 regular, unprotected sexual intercourse or therapeutic donor insemina- 26 tion for a female thirty-five years of age or older; (b) a person's 27 inability to reproduce either as a single individual or with their part- 28 ner without medical intervention; or (c) a licensed physician's or 29 osteopathic physician's findings based on a patient's medical, sexual, 30 or reproductive history, age, physical findings, or diagnostic testing. 31 Earlier evaluation and treatment may be warranted based on an individ- 32 ual's medical history or physical findings. 33 (ii) For purposes of this subsection, "iatrogenic infertility" means 34 an impairment of fertility by surgery, radiation, chemotherapy or other 35 medical treatment affecting reproductive organs or processes. 36 (G) Every large group contract that provides medical, major medical or 37 similar comprehensive-type coverage shall provide coverage for three 38 [cycles of] completed oocyte retrievals and in-vitro fertilization [used 39 in the treatment of infertility] with unlimited embryo transfers from 40 fresh or frozen oocytes or embryos from a covered retrieval, in accord- 41 ance with the guidelines of the American Society for Reproductive Medi- 42 cine, using single embryo transfer (SET) when recommended and medically 43 appropriate for the treatment of infertility. Coverage (i) shall not be 44 denied based on a covered individual's participation in fertility 45 services provided by or to a third party, and (ii) may be subject to 46 annual deductibles and coinsurance, including copayments, as may be 47 deemed appropriate by the superintendent and as are consistent with 48 those established for other benefits within a given contract. [For 49 purposes of this subparagraph, a "cycle" is defined as either all treat- 50 ment that starts when: preparatory medications are administered for 51 ovarian stimulation for oocyte retrieval with the intent of undergoing 52 in-vitro fertilization using a fresh embryo transfer; or medications are 53 administered for endometrial preparation with the intent of undergoing 54 in-vitro fertilization using a frozen embryo transfer.] 55 § 4. This act shall take effect immediately.