OLR Bill Analysis
AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR INFERTILITY TREATMENT AND PROCEDURES
This bill requires certain individual and group health insurance policies to cover medically necessary infertility diagnosis and treatment expenses. It allows a policy to limit the mandatory coverage in specified ways. Current law requires insurers and HMOs to offer infertility diagnosis and treatment, including in-vitro fertilization, coverage to a group plan sponsor, who can reject or accept it.
“Infertility” is the inability of a presumably healthy person to conceive or produce conception or retain a pregnancy during a one-year period. The bill permits the coverage to be excluded for certain religious employers or individuals.
The bill also requires a clinical practice that performs insurance-covered in-vitro fertilization (IVF), gamete intra-fallopian transfer (GIFT), or zygote intra-fallopian transfer (ZIFT) procedures to report certain information to the Department of Public Health (DPH) on forms it prescribes by the February 1 following any year it performs the procedures.
The bill’s coverage requirements apply to individual and group policies delivered, issued, amended, renewed, or continued on and after October 1, 2005 that cover (1) basic hospital expenses, (2) basic medical-surgical expenses, (3) major medical expenses, and (4) hospital or medical services, including those arranged by HMOs.
EFFECTIVE DATE: October 1, 2005
A policy can:
1. limit the number of embryos implanted in any one procedure to two;
2. limit the number of IVF, GIFT, and ZIFT procedures to two;
3. limit coverage to people under age 40;
4. limit coverage to a $ 10,000 lifetime maximum;
5. require covered services be performed at facilities that conform to the standards and guidelines developed by the American College of Obstetricians and Gynecologists or the American Society for Reproductive Medicine;
6. limit coverage to people who have been covered by the policy for at least 12 months;
7. limit IVF, GIFT, and ZIFT coverage to people who have used all reasonable, less expensive, and medically appropriate treatments covered under the policy but remain infertile; and
8. exclude coverage for any person who has had a successful birth as a result of the coverage.
An insurer or HMO can issue a religious employer a health insurance policy that excludes infertility diagnosis and treatment coverage that is contrary to the religious employer's bona fide religious tenets.
If a person states in writing that infertility diagnosis and treatment is contrary to his religious or moral beliefs, an insurer or HMO can issue him a policy or rider that excludes such coverage.
An insurer or HMO that issues a policy excluding the infertility coverage because of the religious exemption must give written notice of the exclusion to each insured or prospective insured. The notice must appear in the policy, application, and sales brochure and be in at least 10-point type.
A “religious employer” is a “qualified church-controlled organization,” as defined in federal law, or a church-affiliated organization. Federal law defines “qualified church-controlled organization” as a church-controlled tax-exempt organization, other than one that (1) offers goods, services, or facilities for sale to the general public, other than those sold at a nominal charge that is substantially less than the actual cost and (2) normally receives more than 25% of its support from either (a) government sources or (b) receipts from admissions, merchandise sales, services performed, or facilities furnished (26 USC § 3121).
A clinical practice must report to DPH the (1) number of insurance-covered IVF, GIFT, and ZIFT procedures performed; (2) total number of multiple births or conceptions; (3) number of births or conceptions per pregnancy; and (4) rates of complications. It must also report, per patient on average and by the number of attempts required, the (1) number of procedures attempted before a successful implantation, (2) number of embryos implanted, and (3) pregnancy rate.
IVF, GIFT, and ZIFT Procedures
IVF is a commonly used technique for treating infertility. It involves using a drug to stimulate a women’s ova (eggs) production. Once mature, the eggs are removed to a culture dish and fertilized with sperm. After fertilization, ova are placed in the woman’s uterus.
In GIFT, ova and sperm are analyzed in vitro to determine suitability, then placed in the woman’s fallopian tubes with sperm, where fertilization can occur naturally. In ZIFT, ova are fertilized in vitro and then placed in the fallopian tubes.
HB 6588, reported favorably by the Public Health Committee, requires individual and group health insurance policies to cover medically necessary infertility diagnosis and treatment expenses for people under age 44, subject to specified conditions and limitations.
Insurance and Real Estate Committee
Joint Favorable Substitute