Bill Text: NY S02619 | 2025-2026 | General Assembly | Introduced
Bill Title: Removes restrictions of three-cycle coverage for in vitro fertilization; mandates individual insurance coverage of in vitro.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2025-01-21 - REFERRED TO INSURANCE [S02619 Detail]
Download: New_York-2025-S02619-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2619 2025-2026 Regular Sessions IN SENATE January 21, 2025 ___________ Introduced by Sen. SCARCELLA-SPANTON -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance 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 all12treatment that starts when: preparatory medications are administered for13ovarian stimulation for oocyte retrieval with the intent of undergoing14in-vitro fertilization using a fresh embryo transfer; or medications are15administered for endometrial preparation with the intent of undergoing16in-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 [three22cycles of in-vitro] in vitro fertilization used in the treatment of 23 infertility. Coverage may be subject to annual deductibles and coinsu- 24 rance, including copayments, as may be deemed appropriate by the super- 25 intendent and as are consistent with those established for other bene- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06387-01-5S. 2619 2 1 fits within a given contract. [For purposes of this subparagraph, a2"cycle" is defined as either all treatment that starts when: preparatory3medications are administered for ovarian stimulation for oocyte4retrieval with the intent of undergoing in-vitro fertilization using a5fresh embryo transfer; or medications are administered for endometrial6preparation with the intent of undergoing in-vitro fertilization using a7frozen embryo transfer.] 8 § 3. Paragraph 13 of subsection (i) of section 3216 of the insurance 9 law, as added by chapter 897 of the laws of 1990 and renumbered by chap- 10 ter 131 of the laws of 1992 and subparagraph (C) as added by section 3 11 of part L of chapter 57 of the laws of 2019, is amended to read as 12 follows: 13 (13) (A) Every policy which provides coverage for hospital care shall 14 not exclude coverage for hospital care for diagnosis and treatment of 15 correctable medical conditions otherwise covered by the policy solely 16 because the medical condition results in infertility[.]; provided, 17 however that: 18 (i) subject to the provisions of subparagraph (C) of this paragraph, 19 in no case shall such coverage exclude surgical or medical procedures 20 provided as part of such hospital care which would correct malformation, 21 disease or dysfunction resulting in infertility; and 22 (ii) provided, further however, that subject to the provisions of 23 subparagraph (C) of this paragraph, in no case shall such coverage 24 exclude diagnostic tests and procedures provided as part of such hospi- 25 tal care that are necessary to determine infertility or that are neces- 26 sary in connection with any surgical or medical treatments or 27 prescription drug coverage provided pursuant to this paragraph, includ- 28 ing such diagnostic tests and procedures as hysterosalpingogram, hyster- 29 oscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital 30 tests, testis biopsy, semen analysis, blood tests and ultrasound; and 31 (iii) provided, further however, every such policy which provides 32 coverage for prescription drugs shall include, within such coverage, 33 coverage for prescription drugs approved by the federal Food and Drug 34 Administration for use in the diagnosis and treatment of infertility in 35 accordance with subparagraph (C) of this paragraph. 36 (B) Every policy which provides coverage for surgical and medical care 37 shall not exclude coverage for surgical and medical care for diagnosis 38 and treatment of correctable medical conditions otherwise covered by the 39 policy solely because the medical condition results in infertility[.]; 40 provided, however that: 41 (i) subject to the provisions of subparagraph (C) of this paragraph, 42 in no case shall such coverage exclude surgical or medical procedures 43 which would correct malformation, disease or dysfunction resulting in 44 infertility; and 45 (ii) provided, further however, that subject to the provisions of 46 subparagraph (C) of this paragraph, in no case shall such coverage 47 exclude diagnostic tests and procedures that are necessary to determine 48 infertility or that are necessary in connection with any surgical or 49 medical treatments or prescription drug coverage provided pursuant to 50 this paragraph, including such diagnostic tests and procedures as 51 hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy, 52 sono-hysterogram, post coital tests, testis biopsy, semen analysis, 53 blood tests and ultrasound; and 54 (iii) provided, further however, every such policy which provides 55 coverage for prescription drugs shall include, within such coverage, 56 coverage for prescription drugs approved by the federal Food and DrugS. 2619 3 1 Administration for use in the diagnosis and treatment of infertility in 2 accordance with subparagraph (C) of this paragraph. 3 (C) [Every policy that provides medical, major medical or similar4comprehensive-type coverage shall provide coverage for] Coverage of 5 diagnostic and treatment procedures, including prescription drugs, used 6 in the diagnosis and treatment of infertility as required by subpara- 7 graphs (A) and (B) of this paragraph shall be provided in accordance 8 with the provisions of this subparagraph. 9 (i) Diagnosis and treatment of infertility shall be prescribed as part 10 of a physician's overall plan of care and consistent with the guidelines 11 for coverage as referenced in this subparagraph. 12 (ii) Coverage may be subject to co-payments, coinsurance and deduct- 13 ibles as may be deemed appropriate by the superintendent and as are 14 consistent with those established for other benefits within a given 15 policy. 16 (iii) Except as provided in items (vi) and (vii) of this subparagraph, 17 coverage shall not be required to include the diagnosis and treatment of 18 infertility in connection with: (I) in vitro fertilization, gamete 19 intrafallopian tube transfers or zygote intrafallopian tube transfers; 20 (II) the reversal of elective sterilizations; (III) sex change proce- 21 dures; (IV) cloning; or (V) medical or surgical services or procedures 22 that are deemed to be experimental in accordance with clinical guide- 23 lines referenced in item (iv) of this subparagraph. 24 (iv) The superintendent, in consultation with the commissioner of 25 health, shall promulgate regulations which shall stipulate the guide- 26 lines and standards which shall be used in carrying out the provisions 27 of this subparagraph, which shall include: 28 (I) The identification of experimental procedures and treatments not 29 covered for the diagnosis and treatment of infertility determined in 30 accordance with the standards and guidelines established and adopted by 31 the American College of Obstetricians and Gynecologists and the American 32 Society for Reproductive Medicine; 33 (II) The identification of the required training, experience and other 34 standards for health care providers for the provision of procedures and 35 treatments for the diagnosis and treatment of infertility determined in 36 accordance with the standards and guidelines established and adopted by 37 the American College of Obstetricians and Gynecologists and the American 38 Society for Reproductive Medicine; and 39 (III) The determination of appropriate medical candidates by the 40 treating physician in accordance with the standards and guidelines 41 established and adopted by the American College of Obstetricians and 42 Gynecologists and/or the American Society for Reproductive Medicine. 43 (v) Coverage shall also include standard fertility preservation 44 services when a medical treatment may directly or indirectly cause 45 iatrogenic infertility to an insured. Coverage may be subject to annual 46 deductibles and coinsurance, including copayments, as may be deemed 47 appropriate by the superintendent and as are consistent with those 48 established for other benefits within a given policy. 49 (vi) Every policy which provides coverage for hospital care shall 50 provide coverage for in vitro fertilization used in the treatment of 51 infertility. Coverage may be subject to annual deductibles and coinsu- 52 rance, including copayments, as may be deemed appropriate by the super- 53 intendent and as are consistent with those established for other bene- 54 fits within a given policy. 55 (vii) (I) For the purposes of this paragraph, "infertility" means a 56 disease or condition characterized by the incapacity to impregnateS. 2619 4 1 another person or to conceive, defined by the failure to establish a 2 clinical pregnancy after twelve months of regular, unprotected sexual 3 intercourse or therapeutic donor insemination, or after six months of 4 regular, unprotected sexual intercourse or therapeutic donor insemina- 5 tion for a female thirty-five years of age or older. Earlier evaluation 6 and treatment may be warranted based on an individual's medical history 7 or physical findings. 8 [(i)] (II) For purposes of this [subparagraph] paragraph, "iatrogenic 9 infertility" means an impairment of fertility by surgery, radiation, 10 chemotherapy or other medical treatment affecting reproductive organs or 11 processes. 12 [(ii)] (viii) No insurer providing coverage under this paragraph shall 13 discriminate based on an insured's expected length of life, present or 14 predicted disability, degree of medical dependency, perceived quality of 15 life, or other health conditions, nor based on personal characteristics, 16 including age, sex, sexual orientation, marital status or gender identi- 17 ty. 18 (D) Every policy that provides coverage for prescription fertility 19 drugs and requires or permits prescription drugs to be purchased through 20 a network participating mail order or other non-retail pharmacy shall 21 provide the same coverage for prescription fertility drugs when such 22 drugs are purchased from a network participating non-mail order retail 23 pharmacy provided that the network participating non-mail order retail 24 pharmacy agrees in advance through a contractual network agreement, to 25 the same reimbursement amount, as well as the same applicable terms and 26 conditions, that the insurer has established for a network participating 27 mail order or other non-retail pharmacy. In such case, the policy shall 28 not impose any fee, co-payment, co-insurance, deductible or other condi- 29 tion on any covered person who elects to purchase prescription fertility 30 drugs through a network participating non-mail order retail pharmacy 31 that it does not impose on any covered person who purchases prescription 32 fertility drugs through a network participating mail order or other 33 non-retail pharmacy; provided, however, that the provisions of this 34 section shall not supersede the terms of a collective bargaining agree- 35 ment or apply to a policy that is the result of a collective bargaining 36 agreement between an employer and a recognized or certified employee 37 organization. 38 § 4. This act shall take effect January 1, 2026 and shall apply to 39 policies and contracts issued, renewed, modified, altered or amended on 40 or after such date.
