Bill Text: MI HB6047 | 2023-2024 | 102nd Legislature | Introduced
Bill Title: Insurance: health insurers; coverage for the treatment of infertility; require.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2024-11-12 - Bill Electronically Reproduced 11/12/2024 [HB6047 Detail]
Download: Michigan-2023-HB6047-Introduced.html
HOUSE BILL NO. 6047
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406cc.
the people of the state of michigan enact:
Sec. 3406cc. (1) Beginning January 1, 2026, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for the treatment of infertility, including all of the following:
(a) Fertility diagnostic care.
(b) Fertility treatment.
(c) Standard fertility preservation services.
(d) At least 4 complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval.
(e) The medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party. However, the insured's coverage must not extend to any medical costs of a surrogate after the embryo transfer.
(f) Coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate.
(2) Coverage for the treatment of infertility under this section must be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
(3) An insurer described in subsection (1) shall not impose any of the following:
(a) 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.
(b) Preexisting condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility or 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 benefits.
(c) 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 the Elliot-Larsen civil rights act 1976 PA 453, MCL 37.2101 to 37.2804, than that provided to other insureds.
(d) Exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications.
(e) Limitations under the policy based on anything other than the medical assessment of an individual's licensed health care provider.
(4) An insurer described in subsection (1) shall provide coverage under this section regardless of whether the insured foregoes a particular fertility treatment or procedure if the insured's health care provider determines that the treatment or procedure is likely to be unsuccessful or the insured seeks to use previously retrieved oocytes or embryos.
(5) This section does not interfere with the clinical judgment of a health care provider. Any clinical guidelines used for a policy subject to the requirements of this section must be based on current guidelines developed by the American Society for Reproductive Medicine, its successor organization, or a comparable organization.
(6) As used in this section:
(a) "Gamete" means sperm or egg.
(b) "Oocyte" means an ovum or egg cell before maturation.
(c) "Fertility diagnostic care" means procedures, products, genetic testing, medications, counseling, and services intended to provide information and counseling about an individual's fertility, including laboratory assessments and imaging studies.
(d) "Fertility treatment" means procedures, products, genetic testing, medications, counseling, and services intended to achieve a pregnancy that results in a live birth and that are provided in a manner consistent with established medical practice and professional guidelines published by the American Society for Reproductive Medicine, its successor organization, or a comparable organization.
(e) "Health care provider" means any of the following:
(i) Nurse practitioner. As used in this subparagraph, "nurse practitioner" means an individual who is licensed as a registered professional nurse under part 172 of the public health code, 1978 PA 368, MCL 333.17201 to 333.17242, who has been granted a specialty certification as a nurse practitioner by the Michigan board of nursing under section 17210 of the public health code, 1978 PA 368, MCL 333.17210.
(ii) Physician.
(iii) Physician's assistant. As used in this subparagraph, "physician's assistant" means an individual who is licensed to engage in the practice as a physician's assistant under part 170, 175, or 180 of the public health code, 1978 PA 368, MCL 333.17001 to 333.17097, MCL 333.17501 to 333.17556, and MCL 333.18001 to 333.18058.
(f) "Infertility" means any of the following:
(i) The presence of a condition recognized by a health care provider as a cause of loss or impairment of fertility, based on an individual's medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
(ii) An individual's inability to establish a pregnancy or to carry a pregnancy to live birth after 12 months of unprotected sexual intercourse when the individual and the individual's partner have the necessary gametes to achieve pregnancy.
(iii) An individual's inability to establish pregnancy after 6 months of unprotected sexual intercourse due to the individual's age when the individual and the individual's partner have the necessary gametes to achieve pregnancy.
(iv) An individual's inability to achieve pregnancy as an individual or with a partner because the individual or the individual and the individual's partner do not have the necessary gametes to achieve 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.
(vi) Infertility as defined by the American Society of Reproductive Medicine, its successor organization, or a comparable organization. Pregnancy resulting in a loss does not cause the time period of trying to achieve a pregnancy to be restarted.
(g) "Physician" means either of the following:
(i) A physician licensed to engage in the practice of medicine under part 170 of the public health code, 1978 PA 368, MCL 333.17001 to 333.17097.
(ii) A physician licensed to engage in the practice of osteopathic medicine and surgery under part 175 of the public health code, 1978 PA 368, MCL 333.17501 to 333.17556.
(h) "Standard fertility preservation services" means procedures, products, genetic testing, medications, counseling, and services intended to preserve fertility, consistent with established medical practice and professional guidelines published by the American Society for Reproductive Medicine, its successor organization, or a comparable organization, for an individual who has a medical or genetic condition 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.
