OLR Bill Analysis

sSB 508 (File 765, as amended by Senate “A”)*

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR INFERTILITY TREATMENT AND PROCEDURES

SUMMARY:

This bill requires certain individual and group health insurance policies to cover the medically necessary costs of diagnosing and treating infertility. It specifies permissible coverage limitations and requirements. It also permits individuals and religious employers to exclude infertility coverage if it is contrary to their religious tenets. The bill repeals current law, which requires insurers and HMOs to only offer infertility coverage to group plan sponsors, who can reject or accept it.

The bill 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 February 1 following any year it performs the procedures.

The bill applies to 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 HMOs.

*Senate Amendment “A” specifies that the permissible coverage limitation on IVF, GIFT, ZIFT, or low tubal ovum transfers is a lifetime limit and that each fertilization or transfer procedure counts toward the maximum as one cycle.

EFFECTIVE DATE: October 1, 2005

INFERTILITY COVERAGE

The bill requires health insurance policies to cover medically necessary expenses incurred for the diagnosis and treatment of infertility, including ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, GIFT, ZIFT, and low tubal ovum transfer. The bill defines “infertility” as the inability of a presumably healthy person to conceive or produce conception or sustain a successful pregnancy during a one-year period.

COVERAGE LIMITATIONS AND REQUIREMENTS

A policy can:

1. limit coverage to people under age 40;

2. limit ovulation induction coverage to four cycles;

3. limit intrauterine insemination coverage to three cycles;

4. place a lifetime limit on IVF, GIFT, ZIFT, or low tubal ovum transfers of two cycles and two embryo implantations per cycle, where each fertilization and transfer procedure counts toward the maximum as one cycle;

5. require covered services be performed at facilities that conform to the standards and guidelines developed by the American Society for Reproductive Medicine or the Society of Reproductive Endocrinology and Infertility;

6. limit coverage to people who have been covered by the policy for at least 12 months;

7. require a person seeking infertility coverage to disclose to her insurer on a form developed by the insurance commissioner any previous infertility treatment or procedures for which she received coverage under a different health insurance policy; and

8. limit IVF, GIFT, ZIFT, and low tubal ovum transfers to people who have used less expensive and medically viable treatments or procedures covered under the policy but remain infertile. But, coverage cannot be denied if a person forgoes a particular treatment when her doctor determines that it is unlikely to be successful.

RELIGIOUS EXEMPTION

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).

REPORTABLE INFORMATION

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) rate 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.

BACKGROUND

Infertility Procedures

Ovulation induction uses medication to stimulate development of one or more mature follicles (where eggs develop) in a woman’s ovaries. IVF uses a drug to stimulate a woman’s egg production. Once mature, the eggs are removed to a culture dish and fertilized with sperm. After fertilization, embryos are placed in the woman’s uterus.

In GIFT, egg and sperm are placed in a woman’s fallopian tubes where fertilization can occur naturally. ZIFT involves placing embryos in a woman’s fallopian tubes. Low tubal ovum transfer involves transferring eggs past a blocked or damaged section of the fallopian tube to an area closer to the uterus. Uterine embryo lavage is a procedure by which the uterus is flushed to recover a preimplantation embryo from a donor and then transferring it to the woman who is to bear the child.

Related Bill

sHB 6588 (File 462), 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.

Legislative History

On April 26, the Senate referred the bill to the Appropriations Committee, which reported it favorably on May 2. On May 4, the Senate referred it to the Public Health Committee, which reported a substitute bill on May 9. The substitute bill revised the coverage limitations that an insurer may include in a policy.

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

9

Nay

7

Appropriations Committee

Joint Favorable Report

Yea

32

Nay

8

Public Health Committee

Joint Favorable Substitute

Yea

19

Nay

6