,,ii #aaeth ,,congress #b;d ,session ,s4 #bifj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bd1 #bjah ,mr4 ,booker introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to require health insurance coverage for the treatment of infertility4 #a4 ,short title ,this ,act may be cited as the ,access to ,infertility ,treatment and ,care ,act4 #b4 ,findings ,congress finds as follows3 7#a7 ,infertility is a medical disease recognized by the ,world ,health ,organization1 the ,american ,society for ,reproductive ,medicine1 and the ,american ,medical ,association that affects men and women equally4 7#b7 ,according to the ,centers for ,disease ,control and ,prevention1 #a in #h couples have difficulty getting pregnant or sustaining a pregnancy4 7#c7 ,infertility affects a broad spectrum of prospective parents4 ,no matter what race1 religion1 sexuality1 or economic status one is1 infertility does not discriminate4 7#d7 ,approximately one-third of infertility is attributed to the female partner1 one-third is attributed to the male partner1 and one-third is caused by a combination of problems in both partners or is unexplained4 7#e7 ,infertility disproportionately affects individuals with particular health complications4 ,for cancer patients and others who must undergo treatments such as chemotherapy1 radiation therapy1 hormone therapy1 or surgery that are likely to harm the reproductive system and organs1 fertility preservation becomes necessary4 7#f7 ,leading causes of infertility include chronic conditions and diseases of the endocrine or metabolic systems1 such as primary ovarian insufficiency1 polycystic ovarian syndrome1 endometriosis1 thyroid disorders1 menstrual cycle defects1 autoimmune disorders1 hormonal imbalances1 testicular disorders1 and urological health issues4 ,other causes include structural problems or blockages within the reproductive system1 exposure to infectious diseases1 occupational or environmental hazards1 or genetic influences4 7#g7 ,recent improvements in therapy and cryopreservation make pregnancy possible for more people than in past years4 7#h7 ,like all other diseases1 infertility and its treatments should be covered by health insurance4 7#i7 ,a #bjag national survey of employer-sponsored health plans found that #dd percent of employers with at least #ejj employees did not cover infertility services1 and #be percent of companies with #bj1jjj or more employees did not cover infertility services4 7#aj7 ,states that do not require insurance coverage of assisted reproductive technology have higher rates of multiple births4 7#aa7 ,the ability to have a family should not be denied to anyone on account of a lack of insurance coverage for medically necessary treatment4 #c4 ,standards relating to benefits for treatment of infertility and iatrogenic infertility 7a7 ,in general ,part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is amended by inserting after section #bgbh the following3 #bgbi4 ,standards relating to benefits for treatment of infertility and iatrogenic infertility 7a7 ,in general ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall ensure that such plan or coverage provides coverage for-- 7#a7 the treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such plan or coverage provides coverage for obstetrical services2 and 7#b7 the treatment of iatrogenic infertility4 7b7 ,definitions ,in this section3 7#a7 the term assisted reproductive technology means treatments or procedures that involve the handling of human egg1 sperm1 and embryo outside of the body with the intent of facilitating a pregnancy1 including in vitro fertilization1 egg or embryo cryopreservation1 egg or embryo donation1 and gestational surrogacy2 7#b7 the term infertility means a disease1 defined by the failure to achieve a successful pregnancy after #ab months or more1 or for women over age #ce1 #f months or more1 of appropriate1 timed unprotected intercourse or therapeutic donor insemination2 and 7#c7 the term iatrogenic infertility means an impairment of fertility due to surgery1 radiation1 chemotherapy1 or other medical treatment4 7c7 ,required coverage 7#a7 ,coverage for infertility ,subject to paragraph 7#c71 a group health plan and a health insurance issuer offering group or individual health insurance coverage that includes coverage for obstetrical services shall provide coverage for treatment of infertility determined appropriate by the treating physician1 including1 as appropriate1 ovulation induction1 egg retrieval1 sperm retrieval1 artificial insemination1 in vitro fertilization1 genetic screening1 intracytoplasmic sperm injection1 and any other nonexperimental treatment1 as determined by the ,secretary in consultation with appropriate professional and patient organizations such as the ,american ,society for ,reproductive ,medicine1 ,,resolve3 ,the ,national ,infertility ,association1 and the ,american ,college of ,obstetricians and ,gynecologists4 7#b7 ,coverage for iatrogenic infertility ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for treatment of fertility preservation services for individuals who undergo medically necessary treatment that may cause iatrogenic infertility1 as determined by the treating physician1 including cryopreservation of gametes and other procedures1 as determined by the ,secretary1 consistent with established medical practices and professional guidelines published by professional medical organizations1 including the ,american ,society for ,clinical ,oncology and the ,american ,society for ,reproductive ,medicine4 7#c7 ,limitation on coverage of assisted reproductive technology ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for assisted reproductive technology as required under paragraph 7#a7 if-- 7,a7 the individual has been unable to bring a pregnancy to a live birth through less costly infertility treatments1 as determined appropriate by the treating physician1 with consideration given to participant's or beneficiary's specific diagnoses or condition for which coverage is available under the plan or coverage2 and 7,b7 the treatment is performed at a medical facility that-- 7i7 conforms to the standards of the ,american ,society for ,reproductive ,medicine and the ,society for ,assisted ,reproductive ,technology2 and 7ii7 is in compliance with any standards set by an appropriate ,federal agency4 7d7 ,limitation ,cost-sharing1 including deductibles and coinsurance1 or other limitations for infertility and iatrogenic infertility therapy may not be imposed with respect to the services required to be covered under subsection 7c7 to the extent that such cost-sharing exceeds the cost-sharing applied to similar services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such similar services4 7e7 ,prohibitions ,a group health plan and a health insurance issuer offering group or individual health insurance coverage may not-- 7#a7 provide incentives 7monetary or otherwise7 to a participant or beneficiary to encourage such participant or beneficiary not to be provided infertility or iatrogenic infertility treatments to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries2 7#b7 prohibit a provider from discussing with a participant or beneficiary infertility or iatrogenic infertility treatment techniques or medical treatment options relating to this section2 or 7#c7 penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility or iatrogenic infertility treatments to a qualified participant or beneficiary in accordance with this section4 7f7 ,rule of construction ,nothing in this section shall be construed to require a participant or beneficiary to undergo infertility or iatrogenic infertility therapy4 7g7 ,notice ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 in the next mailing made by the plan or issuer to the participant or beneficiary2 7#b7 as part of any yearly informational packet sent to the participant or beneficiary2 or 7#c7 not later than ,january #a1 #bjbj1 whichever is earlier4 7h7 ,level and type of reimbursements ,nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section4 4 7b7 ,conforming amendment ,section #bgbd7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bc7;c77 is amended by striking section #bgjd and inserting sections #bgjd and #bgjh4 7c7 ,effective dates 7#a7 ,in general ,the amendments made by subsections 7a7 and 7b7 shall apply for plan years beginning on or after the date that is #f months after the date of enactment of this ,act4 7#b7 ,collective bargaining exception 7,a7 ,in general ,in the case of a group health plan maintained pursuant to #a or more collective bargaining agreements between employee representatives and #a or more employers ratified before the date of enactment of this ,act1 the amendments made by subsection 7a7 shall not apply to plan years beginning before the later of-- 7i7 the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act71 or 7ii7 the date occurring #f months after the date of the enactment of this ,act4 7,b7 ,clarification ,for purposes of subparagraph 7,a71 any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by subsection 7a7 shall not be treated as a termination of such collective bargaining agreement4 #d4 ,federal ,employees ,health ,benefits ,program 7a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7p7 ,coverage for diagnosis and treatment of infertility and iatrogenic infertility 7#a7 ,definitions ,in this subsection1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi of the ,public ,health ,service ,act4 7#b7 ,required coverage ,a contract under this chapter shall provide1 in a manner consistent with section #bgbi of the ,public ,health ,service ,act-- 7,a7 coverage for the diagnosis and treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such contract covers obstetrical benefits2 and 7,b7 coverage for the diagnosis and treatment of iatrogenic infertility4 7#c7 ,cost ,coverage for the diagnosis or treatment of infertility or iatrogenic infertility under a health benefits plan described in section #hijc or #hijc;a may not be subject to any copayment or deductible greater than the copayment or deductible1 respectively1 applicable to obstetrical benefits under the plan4 7#d7 ,preemption ,subsection 7m77#a7 shall not1 with respect to a contract under this chapter1 prevent the inclusion of any terms that1 under paragraph 7#b7 of this subsection1 are required by reason of section #bgbi of the ,public ,health ,service ,act4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to any contract entered into or renewed for a contract year beginning on or after the date that is #ahj days after the date of enactment of this ,act1 and any health benefits plan offered under such a contract4 #e4 ,benefits for treatment of infertility and iatrogenic infertility under the ,,tricare program 7a7 ,in general ,chapter #ee of title #aj1 ,united ,states ,code1 is amended by adding at the end the following new section3 #aaaj;c4 ,obstetrical and infertility benefits 7a7 ,in general ,any health care plan under this chapter shall provide1 in a manner consistent with section #bgbi of the ,public ,health ,service ,act-- 7#a7 coverage for the diagnosis and treatment of infertility1 including nonexperimental assisted reproductive technology procedures1 if such plan covers obstetrical benefits2 and 7#b7 coverage for the diagnosis and treatment of iatrogenic infertility4 7b7 ,copayment ,the ,secretary of ,defense shall establish cost-sharing requirements for the coverage of diagnosis and treatment of infertility and iatrogenic infertility described in subsection 7a7 that are consistent with the cost-sharing requirements applicable to health plans and health insurance coverage under section #bgbi7;d7 of the ,public ,health ,service ,act4 7c7 ,regulations ,the ,secretary of ,defense shall prescribe any regulations necessary to carry out this section4 7d7 ,definitions ,in this section1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi of the ,public ,health ,service ,act4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ee of such title is amended by adding at the end the following new item3 #aaaj;c4 ,obstetrical and infertility benefits4 4 #f4 ,treatment of infertility and iatrogenic infertility for veterans and spouses or partners of veterans 7a7 ,in general ,subchapter ,,ii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #agbj;,j4 ,infertility treatment for veterans and spouses or partners of veterans4 7a7 ,in general ,the ,secretary shall furnish treatment for infertility and iatrogenic infertility1 including through the use of assisted reproductive technology1 to a veteran or a spouse or partner of a veteran if the veteran1 and the spouse or partner of the veteran1 as applicable1 apply jointly for such treatment and counseling through a process prescribed by the ,secretary for purposes of this section4 7b7 ,infertility defined ,in this section1 the terms infertility and iatrogenic infertility have the meanings given those terms in section #bgbi of the ,public ,health ,service ,act4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agbj;,i the following new item3 #agbj;,j4 ,infertility treatment for veterans and spouses or partners of veterans4 4 7c7 ,regulations ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall prescribe regulations to carry out section #agbj;,j of title #ch1 ,united ,states ,code1 as added by subsection 7a74