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General Assembly

 

Substitute Bill No. 508

    January Session, 2005

*_____SB00508INS___032405____*

AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR INFERTILITY TREATMENT AND PROCEDURES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2005) (a) Subject to the limitations set forth in subsection (b) of this section, each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, amended, renewed or continued in this state on or after October 1, 2005, shall provide coverage for the medically necessary expenses of the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception or retain a pregnancy during a one-year period.

(b) Such policy may:

(1) Limit the number of embryos implanted in any one procedure to two;

(2) Limit the number of in-vitro fertilization, gamete intra-fallopian transfer or zygote intra-fallopian transfer procedures to two;

(3) Limit such coverage to individuals who are under forty years of age;

(4) Limit such coverage to a lifetime maximum benefit of ten thousand dollars;

(5) Require that 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 individuals who have maintained coverage under the policy for at least twelve months;

(7) Limit coverage for in-vitro fertilization, gamete intra-fallopian transfer and zygote intra-fallopian transfer to those individuals who have used all reasonable, less expensive and medically appropriate treatments covered under the policy and who are still unable to conceive or produce conception or retain a pregnancy; and

(8) Exclude coverage for any individual who has had a successful birth as a result of such coverage.

(c) (1) Notwithstanding any other provision of this section, any insurance company, hospital or medical service corporation, or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital or medical service corporation, or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods.

(d) Any health insurance policy issued pursuant to subsection (c) of this section shall provide written notice to each insured or prospective insured that methods of diagnosis and treatment of infertility are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

(e) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization", as defined in 26 USC 3121 or a church-affiliated organization.

Sec. 2. Section 38a-536 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2005):

[Any insurance company, hospital service corporation or medical service corporation authorized to do the business of health insurance in this state shall offer to any individual, partnership, corporation or unincorporated association providing group hospital or medical insurance coverage for its employees a group hospital or medical service plan or contract providing coverage for the medically necessary expenses of the diagnosis and treatment of infertility, including in-vitro fertilization procedures.]

(a) Subject to the limitations set forth in subsection (b) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after October 1, 2005, shall provide coverage for the medically necessary expenses of the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception [,] or retain a pregnancy during a one-year period.

(b) Such policy may:

(1) Limit the number of embryos implanted in any one procedure to two;

(2) Limit the number of in-vitro fertilization, gamete intra-fallopian transfer or zygote intra-fallopian transfer procedures to two;

(3) Limit such coverage to individuals who are under forty years of age;

(4) Limit such coverage to a lifetime maximum benefit of ten thousand dollars;

(5) Require that 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 individuals who have maintained coverage under the policy for at least twelve months;

(7) Limit coverage for in-vitro fertilization, gamete intra-fallopian transfer and zygote intra-fallopian transfer to those individuals who have used all reasonable, less expensive and medically appropriate treatments covered under the policy and who are still unable to conceive or produce conception or retain a pregnancy; and

(8) Exclude coverage for any individual who has had a successful birth as a result of such coverage.

(c) (1) Notwithstanding any other provision of this section, any insurance company, hospital or medical service corporation, or health care center may issue to a religious employer a group health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital or medical service corporation, or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods.

(d) Any health insurance policy issued pursuant to subsection (c) of this section shall provide written notice to each insured or prospective insured that methods of diagnosis and treatment of infertility are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

(e) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization", as defined in 26 USC 3121 or a church-affiliated organization.

Sec. 3. (NEW) (Effective October 1, 2005) (a) Any clinical practice in this state that performs in-vitro fertilization, gamete intra-fallopian transfer or zygote intra-fallopian transfer procedures that are covered by insurance shall report to the Department of Public Health, not later than February first following any year such procedures were performed, the following information:

(1) The number of such procedures performed;

(2) The number of multiple births or conceptions with a breakdown of the number of births or conceptions per pregnancy;

(3) The number of procedures attempted before a successful implantation (A) per patient on average, and (B) grouped by the number of attempts required;

(4) The number of embryos implanted (A) per patient on average, and (B) grouped by the number of attempts required;

(5) The pregnancy rate (A) per patient on average, and (B) grouped by the number of attempts required; and

(6) The rates of complications.

(b) Such information shall be submitted on such forms as the department prescribes.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2005

New section

Sec. 2

October 1, 2005

38a-536

Sec. 3

October 1, 2005

New section

INS

Joint Favorable Subst.