,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #eife  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #bd1 #bjah,ms4   
,de,lauro introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committees 
on ,ov]sight & ,gov]nm5t ,re=m1 ,arm$   
,s]vices1 & ,vet]ans' ,affairs1 = a     
p]iod to be subsequ5tly det]m9$ by !    
,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to      
require heal? insurance cov]age = !     
treatm5t ( inf]tility4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,access to    
,inf]tility ,treatm5t & ,c>e ,act4  #b4 
,f9d+s ,congress f9ds z foll[s3  7#a7   
,inf]tility is a m$ical disease         
recogniz$ by ! ,_w ,heal? ,organization1
 ! ,am]ican ,society = ,reproductive    
,m$ic9e1 & ! ,am]ican ,m$ical           
,association t affects m5 & wom5        
equally4  7#b7 ,accord+ to ! ,c5t]s =   
,disease ,control & ,prev5tion1 #a 9 #h 
c\ples h difficulty gett+ pregnant or   

su/a9+ a pregnancy4  7#c7 ,inf]tility   
affects a broad spectrum ( prospective  
p>5ts4 ,no matt] :at race1 religion1    
sexuality1 or economic /atus "o is1     
inf]tility does n discrim9ate4  7#d7    
,approximately "o-?ird ( inf]tility is  
attribut$ to ! female p>tn]1 "o-?ird is 
attribut$ to ! male p>tn]1 & "o-?ird is 
caus$ by a comb9ation ( problems 9 bo?  
p>tn]s or is unexpla9$4  7#e7           
,inf]tility disproportionately affects  
individuals ) p>ticul> heal?            
complications4 ,= canc] pati5ts & o!rs  
:o mu/ und]go treatm5ts su* z *emo!rapy1
 radiation !rapy1 hormone !rapy1 or     
surg]y t are likely to h>m !            
reproductive sy/em & organs1 f]tility   
pres]vation becomes necess>y4  7#f7     
,lead+ causes ( inf]tility include      
*ronic conditions & diseases ( !        
endocr9e or metabolic sy/ems1 su* z     
prim>y ov>ian insuffici5cy1 polycy/ic   
ov>ian syndrome1 endometriosis1 ?yroid  
disord]s1 m5/rual cycle defects1        
autoimmune disord]s1 hormonal           

imbalances1 te/icul> disord]s1 &        
urological heal? issues4 ,o!r causes    
include /ructural problems or blockages 
)9 ! reproductive sy/em1 exposure to    
infecti\s diseases1 occupational or     
environm5tal haz>ds1 or g5etic          
influ5ces4  7#g7 ,rec5t improvem5ts 9   
!rapy & cryopres]vation make pregnancy  
possible = m p ?an 9 pa/ ye>s4  7#h7 ,l 
all o!r diseases1 inf]tility & its      
treatm5ts %\ld be cov]$ by heal?        
insurance4  7#i7 ,a #bjag national      
survey ( employ]-sponsor$ heal? plans   
f\nd t #dd p]c5t ( employ]s ) at lea/   
#ejj employees did n cov] inf]tility    
s]vices1 & #be p]c5t ( companies )      
#bj1jjj or m employees did n cov]       
inf]tility s]vices4  7#aj7 ,/ates t d n 
require insurance cov]age ( assi/$      
reproductive te*nology h high] rates (  
multiple bir?s4  7#aa7 ,! ability to h a
 family %\ld n be d5i$ to anyone on     
acc\nt ( a lack ( insurance cov]age =   
m$ically necess>y treatm5t4  #c4 ,/&>ds 
relat+ to b5efits = treatm5t (          

inf]tility & iatrog5ic inf]tility  7a7  
,9 g5]al ,"p ,a ( title ,,xxvii ( !     
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg et seq47 is am5d$ by  
ins]t+ aft] section #bgbh ! foll[+3     
#bgbi4 ,/&>ds relat+ to b5efits =       
treatm5t ( inf]tility & iatrog5ic       
inf]tility  7a7 ,9 g5]al ,a gr\p heal?  
plan or a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age %all ensure t su* plan or       
cov]age provides cov]age =--  7#a7 !    
treatm5t ( inf]tility1 includ+          
nonexp]im5tal assi/$ reproductive       
te*nology proc$ures1 if su* plan or     
cov]age provides cov]age = ob/etrical   
s]vices2 &  7#b7 ! treatm5t ( iatrog5ic 
inf]tility4  7b7 ,def9itions ,9 ?is     
section3  7#a7 ! t]m assi/$ reproductive
 te*nology means treatm5ts or proc$ures 
t involve ! h&l+ ( human egg1 sp]m1 &   
embryo outside ( ! body ) ! int5t (     
facilitat+ a pregnancy1 includ+ 9 vitro 
f]tilization1 egg or embryo             
cryopres]vation1 egg or embryo donation1

 & ge/ational surrogacy2  7#b7 ! t]m    
inf]tility means a disease1 def9$ by !  
failure to a*ieve a successful pregnancy
 aft] #ab mon?s or m1 or = wom5 ov] age 
#ce1 #f mon?s or m1 ( appropriate1 tim$ 
unprotect$ int]c\rse or !rapeutic donor 
insem9ation2 &  7#c7 ! t]m iatrog5ic    
inf]tility means an impairm5t ( f]tility
 due to surg]y1 radiation1 *emo!rapy1 or
 o!r m$ical treatm5t4  7c7 ,requir$     
cov]age  7#a7 ,cov]age = inf]tility     
,subject to p>agraph 7#c71 a gr\p heal? 
plan & a heal? insurance issu] (f]+ gr\p
 or individual heal? insurance cov]age t
 includes cov]age = ob/etrical s]vices  
%all provide cov]age = treatm5t (       
inf]tility det]m9$ appropriate by !     
treat+ physician1 includ+1 z            
appropriate1 ovulation induction1 egg   
retrieval1 sp]m retrieval1 artificial   
insem9ation1 9 vitro f]tilization1      
g5etic scre5+1 intracytoplasmic sp]m    
injection1 & any o!r non-exp]im5tal     
treatm5t1 z det]m9$ by ! ,secret>y 9    
consultation ) appropriate pr(essional &

 pati5t organizations su* z ! ,am]ican  
,society = ,reproductive ,m$ic9e1       
,,resolve3 ,! ,national ,inf]tility     
,association1 & ! ,am]ican ,college (   
,ob/etricians & ,gynecologi/s4  7#b7    
,cov]age = iatrog5ic inf]tility ,a gr\p 
heal? plan & a heal? insurance issu]    
(f]+ gr\p or individual heal? insurance 
cov]age %all provide cov]age = treatm5t 
( f]tility pres]vation s]vices =        
individuals :o und]go m$ically necess>y 
treatm5t t may cause iatrog5ic          
inf]tility1 z det]m9$ by ! treat+       
physician1 includ+ cryopres]vation (    
gametes & o!r proc$ures1 z det]m9$ by ! 
,secret>y1 consi/5t ) e/abli%$ m$ical   
practices & pr(essional guidel9es       
publi%$ by pr(essional m$ical           
organizations1 includ+ ! ,am]ican       
,society = ,cl9ical ,oncology & !       
,am]ican ,society = ,reproductive       
,m$ic9e4  7#c7 ,limitation on cov]age ( 
assi/$ reproductive te*nology ,a gr\p   
heal? plan & a heal? insurance issu]    
(f]+ gr\p or individual heal? insurance 

cov]age %all provide cov]age = assi/$   
reproductive te*nology z requir$ "u     
p>agraph 7#a7 if--  7,a7 ! individual   
has be5 unable to br+ a pregnancy to a  
live bir? ?r\gh less co/ly inf]tility   
treatm5ts1 z det]m9$ appropriate by !   
treat+ physician1 ) consid]ation giv5 to
 p>ticipant's or b5efici>y's specific   
diagnoses or condition = :i* cov]age is 
available "u ! plan or cov]age2 &  7,b7 
! treatm5t is p]=m$ at a m$ical facility
 t-- 7i7 con=ms to ! /&>ds ( ! ,am]ican 
,society = ,reproductive ,m$ic9e & !    
,society = ,assi/$ ,reproductive        
,te*nology2 &  7ii7 is 9 compliance )   
any /&>ds set by an appropriate ,f$]al  
ag5cy4  7d7 ,limitation ,co/-%>+1       
includ+ deductibles & co9surance1 or o!r
 limitations = inf]tility & iatrog5ic   
inf]tility !rapy may n be impos$ )      
respect to ! s]vices requir$ to be cov]$
 "u subsection 7c7 to ! ext5t t su*     
co/-%>+ exce$s ! co/-%>+ appli$ to      
simil> s]vices "u ! gr\p heal? plan or  
heal? insurance cov]age or su* o!r      

limitations are diff]5t f limitations   
impos$ ) respect to su* simil> s]vices4 
7e7 ,prohibitions ,a gr\p heal? plan & a
 heal? insurance issu] (f]+ gr\p or     
individual heal? insurance cov]age may  
n--  7#a7 provide inc5tives 7monet>y or 
o!rwise7 to a p>ticipant or b5efici>y to
 enc\rage su* p>ticipant or b5efici>y n 
to be provid$ inf]tility or iatrog5ic   
inf]tility treatm5ts to :i* su*         
p>ticipant or b5efici>y is entitl$ "u   
?is section or to provid]s to induce su*
 provid]s n to provide su* treatm5ts to 
qualifi$ p>ticipants or b5efici>ies2    
7#b7 prohibit a provid] f discuss+ ) a  
p>ticipant or b5efici>y inf]tility or   
iatrog5ic inf]tility treatm5t te*niques 
or m$ical treatm5t options relat+ to ?is
 section2 or  7#c7 p5alize or o!rwise   
r$uce or limit ! reimbursem5t ( a       
provid] because su* provid] provid$     
inf]tility or iatrog5ic inf]tility      
treatm5ts to a qualifi$ p>ticipant or   
b5efici>y 9 accordance ) ?is section4   
7f7 ,rule ( con/ruction ,no?+ 9 ?is     

section %all be con/ru$ to require a    
p>ticipant or b5efici>y to und]go       
inf]tility or iatrog5ic inf]tility      
!rapy4  7g7 ,notice ,a gr\p heal? plan &
 a heal? insurance issu] (f]+ gr\p or   
individual heal? insurance cov]age %all 
provide notice to ea* p>ticipant &      
b5efici>y "u su* plan reg>d+ ! cov]age  
requir$ by ?is section 9 accordance )   
regulations promulgat$ by ! ,secret>y4  
,su* notice %all be 9 writ+ & prom95tly 
position$ 9 any lit]ature or            
correspond5ce made available or         
di/ribut$ by ! plan or issu] & %all be  
transmitt$--  7#a7 9 ! next mail+ made  
by ! plan or issu] to ! p>ticipant or   
b5efici>y2  7#b7 z "p ( any ye>ly       
in=mational packet s5t to ! p>ticipant  
or b5efici>y2 or  7#c7 n lat] ?an       
,janu>y #a1 #bjbj1  :i*ev] is e>li]4    
7h7 ,level & type ( reimbursem5ts ,no?+ 
9 ?is section %all be con/ru$ to prev5t 
a gr\p heal? plan or a heal? insurance  
issu] (f]+ gr\p or individual heal?     
insurance cov]age f negotiat+ ! level & 

type ( reimbursem5t ) a provid] = c>e   
provid$ 9 accordance ) ?is section4  4  
7b7 ,con=m+ am5dm5t ,section #bgbd7;c7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #cjj;gg-#bc7;c77 is am5d$ by  
/rik+ section #bgjd & ins]t+ sections   
#bgjd & #bgjh4  7c7 ,effective dates    
7#a7 ,9 g5]al ,! am5dm5ts made by       
subsections 7a7 & 7b7 %all apply = plan 
ye>s beg9n+ on or aft] ! date t is #f   
mon?s aft] ! date ( enactm5t ( ?is ,act4
  7#b7 ,collective b>ga9+ exception     
7,a7 ,9 g5]al ,9 ! case ( a gr\p heal?  
plan ma9ta9$ pursuant to #a or m        
collective b>ga9+ agreem5ts betwe5      
employee repres5tatives & #a or m       
employ]s ratifi$ be=e ! date ( enactm5t 
( ?is ,act1 ! am5dm5ts made by          
subsection 7a7 %all n apply to plan ye>s
 beg9n+ be=e ! lat] (--  7i7 ! date on  
:i* ! la/ collective b>ga9+ agreem5ts   
relat+ to ! plan t]m9ates 7det]m9$ )\t  
reg>d to any ext5sion !re( agre$ to aft]
 ! date ( enactm5t ( ?is ,act71 or  7ii7
 ! date occurr+ #f mon?s aft] ! date ( !

 enactm5t ( ?is ,act4  7,b7             
,cl>ification ,= purposes ( subp>agraph 
7,a71 any plan am5dm5t made pursuant to 
a collective b>ga9+ agreem5t relat+ to !
 plan :i* am5ds ! plan solely to con=m  
to any requirem5t add$ by subsection 7a7
 %all n be treat$ z a t]m9ation ( su*   
collective b>ga9+ agreem5t4  #d4 ,f$]al 
,employees ,heal? ,b5efits ,program  7a7
 ,9 g5]al ,section #hijb ( title #e1    
,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+3  7p7 ,cov]age =        
diagnosis & treatm5t ( inf]tility &     
iatrog5ic inf]tility  7#a7 ,def9itions  
,9 ?is subsection1 ! t]ms inf]tility &  
iatrog5ic inf]tility h ! mean+s giv5 ^? 
t]ms 9 section #bgbi ( ! ,public ,heal? 
,s]vice ,act4  7#b7 ,requir$ cov]age ,a 
contract "u ?is *apt] %all provide1 9 a 
mann] consi/5t ) section #bgbi ( !      
,public ,heal? ,s]vice ,act--  7,a7     
cov]age = ! diagnosis & treatm5t (      
inf]tility1 includ+ nonexp]im5tal assi/$
 reproductive te*nology proc$ures1 if   
su* contract cov]s ob/etrical b5efits2 &

  7,b7 cov]age = ! diagnosis & treatm5t 
( iatrog5ic inf]tility4  7#c7 ,co/      
,cov]age = ! diagnosis or treatm5t (    
inf]tility or iatrog5ic inf]tility "u a 
heal? b5efits plan describ$ 9 section   
#hijc or #hijc;a may n be subject to any
 copaym5t or d$uctible great] ?an !     
copaym5t or d$uctible1 respectively1    
applicable to ob/etrical b5efits "u !   
plan4  7#d7 ,preemption ,subsection     
7m77#a7 %all n1 ) respect to a contract 
"u ?is *apt]1 prev5t ! inclusion ( any  
t]ms t1 "u p>agraph 7#b7 ( ?is          
subsection1 are requir$ by reason (     
section #bgbi ( ! ,public ,heal? ,s]vice
 ,act4  4  7b7 ,effective date ,!       
am5dm5t made by subsection 7a7 %all     
apply ) respect to any contract ent]$   
into or r5ew$ = a contract ye> beg9n+ on
 or aft] ! date t is #ahj days aft] !   
date ( enactm5t ( ?is ,act1 & any heal? 
b5efits plan (f]$ "u su* a contract4    
#e4 ,b5efits = treatm5t ( inf]tility &  
iatrog5ic inf]tility "u ! ,,tric>e      
program  7a7 ,9 g5]al ,*apt] #ee ( title

 #aj1 ,unit$ ,/ates ,code1 is am5d$ by  
add+ at ! end ! foll[+ new section3     
#aaaj;c4 ,ob/etrical & inf]tility       
b5efits  7a7 ,9 g5]al ,any heal? c>e    
plan "u ?is *apt] %all provide1 9 a     
mann] consi/5t ) section #bgbi ( !      
,public ,heal? ,s]vice ,act--  7#a7     
cov]age = ! diagnosis & treatm5t (      
inf]tility1 includ+ nonexp]im5tal assi/$
 reproductive te*nology proc$ures1 if   
su* plan cov]s ob/etrical b5efits2 &    
7#b7 cov]age = ! diagnosis & treatm5t ( 
iatrog5ic inf]tility4  7b7 ,copaym5t ,! 
,secret>y ( ,def5se %all e/abli% co/-%>+
 requirem5ts = ! cov]age ( diagnosis &  
treatm5t ( inf]tility & iatrog5ic       
inf]tility describ$ 9 subsection 7a7 t  
are consi/5t ) ! co/-%>+ requirem5ts    
applicable to heal? plans & heal?       
insurance cov]age "u section #bgbi7;d7 (
 ! ,public ,heal? ,s]vice ,act4  7c7    
,regulations ,! ,secret>y ( ,def5se %all
 prescribe any regulations necess>y to  
c>ry out ?is section4  7d7 ,def9itions  
,9 ?is section1 ! t]ms inf]tility &     

iatrog5ic inf]tility h ! mean+s giv5 ^? 
t]ms 9 section #bgbi ( ! ,public ,heal? 
,s]vice ,act4  4  7b7 ,cl]ical am5dm5t  
,! table ( sections at ! beg9n+ ( *apt] 
#ee ( su* title is am5d$ by add+ at !   
end ! foll[+ new item3  #aaaj;c4        
,ob/etrical & inf]tility b5efits4  4    
#f4 ,treatm5t ( inf]tility & iatrog5ic  
inf]tility = vet]ans & sp\ses or p>tn]s 
( vet]ans  7a7 ,9 g5]al ,sub*apt] ,,ii (
 *apt] #ag ( title #ch1 ,unit$ ,/ates   
,code1 is am5d$ by add+ at ! end !      
foll[+ new section3  #agbj;,j4          
,inf]tility treatm5t & c\nsel+ = vet]ans
 & sp\ses or p>tn]s ( vet]ans  7a7 ,9   
g5]al ,! ,secret>y %all furni% treatm5t 
= inf]tility & iatrog5ic inf]tility1    
includ+ ?r\gh ! use ( assi/$            
reproductive te*nology1 to a vet]an or a
 sp\se or p>tn] ( a vet]an if ! vet]an1 
& ! sp\se or p>tn] ( ! vet]an1 z        
applicable1 apply jo9tly = su* treatm5t 
& c\nsel+ ?r\gh a process prescrib$ by !
 ,secret>y = purposes ( ?is section4    
7b7 ,inf]tility def9$ ,9 ?is section1 ! 

t]ms inf]tility & iatrog5ic inf]tility h
 ! mean+s giv5 ^? t]ms 9 section #bgbi (
 ! ,public ,heal? ,s]vice ,act4  4  7b7 
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #ag ( su* title is     
am5d$ by ins]t+ aft] ! item relat+ to   
section #agbj;,i ! foll[+ new item3     
#agbj;,j4 ,inf]tility treatm5t & c\nsel+
 = vet]ans & sp\ses or p>tn]s ( vet]ans4
  4  7c7 ,regulations ,n lat] ?an #ah   
mon?s aft] ! date ( ! enactm5t ( ?is    
,act1 ! ,secret>y ( ,vet]ans ,affairs   
%all prescribe regulations to c>ry out  
section #agbj;,j ( title #ch1 ,unit$    
,/ates ,code1 z add$ by subsection 7a74