,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #hhba  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #be1 #bjbd ,mrs4
 ,*avez-,de,remer 7= h]self1 ,mr4 ,nunn 
( ,i[a1 ,ms4 ,wild1 & ,ms4 ,wass]man    
,s*ultz7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,education & !
 ,work=ce  ,a ,,bill  ,to ensure cov]age
 = ! treatm5t ( inf]tility = c]ta9      
conditions4  #a4 ,%ort title ,?is ,act  
may be cit$ z ! ,help+ to ,optimize     
,pati5ts' ,exp]i5ce ) ,f]tility ,s]vices
 ,act or ! ,,hope ) ,f]tility ,s]vices  
,act4  #b4 ensur+ b5efits = treatm5t (  
inf]tility & iatrog5ic inf]tility  7a7  
,9 g5]al ,subp>t ,b ( "p #g ( subtitle  
,b ( title ,i ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe et seq47 is am5d$ by    
ins]t+ aft] section #gad ! foll[+3      
#gad;,a4 ,/&>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 heal? insurance cov]age %all ensure

 t su* plan or cov]age provides cov]age 
= inf]tility or iatrog5ic inf]tility    
treatm5ts1 includ+-- 7#a7 ! treatm5t (  
inf]tility1 if su* plan or cov]age      
provides cov]age = ob/etrical s]vices2 &
  7#b7 /&>d f]tility pres]vation s]vices
 :5 a m$ically necess>y treatm5t        
describ$ 9 subp>agraph 7,a71 7,b71 7,c71
 or 7,d7 ( subsection 7b77#a7 causes1 or
 is expect$ to cause1 iatrog5ic         
inf]tility4  7b7 ,def9itions ,9 ?is     
section3  7#a7 ,iatrog5ic inf]tility ,! 
t]m iatrog5ic inf]tility means an       
impairm5t ( f]tility due to damage (    
reproductive organs & processes result+ 
f-- 7,a7 a surgical or o!r invasive     
m$ical proc$ure z a result ( an injury  
or life-?reat5+ illness1 or involv+ a   
reproductive organ or process 9 a mann] 
likely to cause damage to su* organ or  
process2  7,b7 radiation !rapy2  7,c7   
*emo!rapy2 or  7,d7 myeloablative       
condition+4  7#b7 ,inf]tility ,! t]m    
inf]tility means a disease or condition 
*>act]iz$ by--  7,a7 ! inability to     

a*ieve spontane\s pregnancy )\t m$ical  
treatm5t aft] a p]iod ( at lea/ #ab     
consecutive mon?s ( unprotect$ sexual   
int]c\rse2  7,b7 ! inability to a*ieve  
pregnancy aft] receiv+ /&>d cl9ical     
treatm5t protocols "u ! sup]vision ( a  
treat+ physician :o is a bo>d-c]tifi$   
reproductive endocr9ologi/ or           
ob/etrician-gynecologi/2  7,c7 be+      
incapable ( reproduction to live bir?   
bas$ on m$ical & reproductive hi/ory1   
age1 physical f9d+s or diagno/ic te/+ ( 
! individual1 z det]m9$ by a treat+     
physician2 or  7,d7 ! inability to      
a*ieve spontane\s pregnancy on acc\nt ( 
a diagnos$ condition t is a disord] (   
ovulation1 or a te/icul> or hormonal    
disease or disord]4  7#c7 ,inf]tility or
 iatrog5ic inf]tility treatm5t ,! t]m   
inf]tility or iatrog5ic inf]tility      
treatm5t means treatm5ts or proc$ures ) 
! int5t ( facilitat+ a pregnancy1       
includ+-- 7,a7 su* treatm5ts or         
proc$ures t involve ! h&l+ ( human egg1 
sp]m1 & embryo outside ( ! body1 includ+

 9 vitro f]tilization & maturation1 egg 
& embryo cryopres]vation1 egg & embryo  
donation1 & intracytoplasmic sp]m       
injection2 or  7,b7 su* treatm5ts or    
proc$ures t d n involve ! h&l+ ( human  
egg1 sp]m1 & embryo outside ( ! body1   
includ+ ovulation induction1 g5etic     
scre5+ & diagnosis1 sp]m                
cryopres]vation1 & intraut]9e           
insem9ation4  7c7 ,requir$ cov]age ,a   
gr\p heal? plan & a heal? insurance     
issu] (f]+ gr\p heal? insurance cov]age 
t includes cov]age = ob/etrical s]vices 
%all provide compreh5sive cov]age =     
inf]tility or iatrog5ic inf]tility      
treatm5ts1 z det]m9$ by ! ,secret>y 9   
consultation ) relevant /akehold]s1     
provid$ to a p>ticipant or b5efici>y    
if--  7#a7 ! p>ticipant or b5efici>y has
 inf]tility1 includ+ iatrog5ic          
inf]tility2 &  7#b7 ! treatm5t or s]vice
 is p]=m$ at a m$ical facility t is 9   
compliance ) /&>ds set by appropriate   
,f$]al & ,/ate ag5cies4  7d7 ,f9ancial  
requirem5ts & treatm5t requirem5ts ,any 

cov]age provid$ by a gr\p heal? plan or 
heal? insurance issu] 9 accordance ) ?is
 section may be subject to cov]age      
limits 7su* z m$ical necessity1         
pre-au?orization1 or pre-c]tification7 &
 co/-%>+ requirem5ts 7su* z co9surance1 
copaym5ts1 & d$uctibles71 z requir$ "u !
 gr\p heal? plan or heal? insurance     
cov]age1 t are no m re/rictive ?an !    
pr$om9ant cov]age limits & co/-%>+      
requirem5ts appli$ to sub/antially all  
m$ical & surgical b5efits cov]$ "u !    
plan or cov]age4  7e7 ,prohibitions ,a  
gr\p heal? plan & a heal? insurance     
issu] (f]+ gr\p 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 section1 or to provid]s to induce
 su* provid]s n to provide su* treatm5ts
 to qualifi$ p>ticipants & b5efici>ies2 
7#b7 prohibit a provid] f discuss+ ) a  

p>ticipant or b5efici>y inf]tility or   
iatrog5ic inf]tility treatm5ts or m$ical
 treatm5t options requir$ to be cov]$ "u
 ?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      
treatm5t s]vices to a p>ticipant or     
b5efici>y 9 accordance ) ?is section4   
7f7 ,rule ( con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to--  7#a7      
require a p>ticipant or b5efici>y 9 a   
gr\p heal? plan or gr\p heal? insurance 
cov]age to und]go inf]tility or         
iatrog5ic inf]tility treatm5ts2  7#b7   
impact ! use by a gr\p heal? plan or a  
heal? insurance issu] (f]+ gr\p heal?   
insurance cov]age ( utilization         
managem5t tools2 or  7#c7 prev5t a gr\p 
heal? plan or a heal? insurance issu]   
(f]+ gr\p heal? insurance cov]age f     
contract+ ) provid]s z to ! level & type
 ( reimbursem5t ) a provid] = c>e       
provid$ 9 accordance ) ?is section4  7g7
 ,utilization managem5t tools           

requirem5ts  7#a7 ,9 g5]al ,9 ! case ( a
 gr\p heal? plan or a heal? insurance   
issu] (f]+ gr\p heal? insurance cov]age 
t imposes utilization managem5t tools on
 inf]tility & iatrog5ic inf]tility      
treatm5t b5efits1 = ! fir/ #e plan ye>s 
t beg9 aft] ! date ( enactm5t ( ! ,help+
 to ,optimize ,pati5ts' ,exp]i5ce )     
,f]tility ,s]vices ,act1 su* plan or    
issu] %all p]=m & docum5t analyses ( !  
design & application ( ! utilization    
managem5t tool su* analysis & ! foll[+  
in=mation3  7,a7 ,! specific plan or    
cov]age t]ms or o!r relevant t]ms reg>d+
 ! utilization managem5t tools & a      
description ( all inf]tility or         
iatrog5ic inf]tility treatm5t b5efits1  
to :i* ea* su* t]m applies 9 ea*        
respective b5efits classification4  7,b7
 ,! factors us$ to det]m9e t !          
utilization managem5t tool w apply to   
inf]tility or iatrog5ic inf]tility      
treatm5t b5efits4  7,c7 ,! evid5ti>y    
/&>ds us$ = ! factors id5tifi$ "u       
subp>agraph 7,b71 :5 applicable1 provid$

 t e factor %all be def9$1 & any o!r    
s\rce or evid5ce reli$ ^u to design &   
apply ! utilization managem5t tool to   
inf]tility & iatrog5ic inf]tility       
treatm5t b5efits4  7,d7 ,an analysis    
demon/rat+ t ! processes1 /rategies1    
evid5ti>y /&>ds1 & o!r factors us$ to   
apply ! utilization managem5t tools to  
inf]tility & iatrog5ic inf]tility       
treatm5t b5efits z writt5 & 9 op]ation1 
are consi/5t )1 & are appli$ no m       
/r+5tly ?an ) cl9ical guidel9es =       
inf]tility or iatrog5ic inf]tility      
treatm5ts4  7,e7 ,! specific f9d+s &    
conclusions rea*$ by ! gr\p heal? plan  
or heal? insurance issu] ) respect to ! 
heal? insurance cov]age1 includ+ any    
results ( ! analyses describ$ 9 ?is     
p>agraph t indicate t ! plan or cov]age 
is or is n 9 compliance ) ?is section4  
7#b7 ,submission process  7,a7 ,annual  
submission ,a gr\p heal? plan or heal?  
insurance issu] (f]+ gr\p heal?         
insurance cov]age %all submit to !      
,secret>y ! analyses describ$ 9 p>agraph

 7#a7 annually = fir/ #e plan ye>s t    
beg9 aft] ! date ( enactm5t ( ! ,help+  
to ,optimize ,pati5ts' ,exp]i5ce )      
,f]tility ,s]vices ,act4 ,= subsequ5t   
plan ye>s1 ! ,secret>y may reque/ t a   
gr\p heal? plan or a heal? insurance    
issu] (f]+ gr\p heal? insurance cov]age 
submit ! analysis describ$ 9 p>agraph   
7#a7 9 ! case ( pot5tial violations (   
?is section or compla9ts reg>d+         
noncompliance ) ?is section t conc]n    
utilization managem5t tools & any o!r   
in/ances 9 :i* ! ,secret>y det]m9es     
appropriate4  7,b7 ,additional in=mation
 ,if ! ,secret>y concludes t a gr\p     
heal? plan or heal? insurance issu] has 
n submitt$ suffici5t in=mation = !      
,secret>y to review ! analysis describ$ 
9 p>agraph 7#a71 ! ,secret>y %all       
specify to ! plan or issu] ! in=mation !
 plan or issu] is requir$ to submit     
pursuant to subp>agraph 7,a74 ,no?+ 9   
?is subp>agraph %all require ! ,secret>y
 to conclude t a gr\p heal? plan or     
heal? insurance issu] is 9 compliance ) 

?is section solely bas$ ^u ! inspection 
( ! analyses describ$ 9 p>agraph 7#a71 z
 reque/$ "u subp>agraph 7,a74  7#c7     
,requir$ action  7,a7 ,9 g5]al ,if1 aft]
 review ( ! analyses describ$ 9 p>agraph
 7#a71 ! ,secret>y notifies ! gr\p heal?
 plan or heal? insurance issu] t su*    
plan or issu] is n 9 compliance ) ?is   
section1 ! plan or issu]--  7i7 %all    
specify to ! ,secret>y ! actions ! plan 
or issu] w take to be 9 compliance ) ?is
 section & provide to ! ,secret>y       
additional analyses describ$ 9 p>agraph 
7#a7 t demon/rate compliance ) ?is      
section n lat] ?an #de days aft] !      
initial notification by ! ,secret>y t ! 
plan or issu] is n 9 compliance2 &  7ii7
 foll[+ ! #de-;day corrective action    
p]iod "u clause 7i71 if ! ,secret>y     
makes a f9al det]m9ation t ! plan or    
issu] /ill is n 9 compliance ) ?is      
section1 n lat] ?an #g days aft] su*    
det]m9ation1 %all notify all individuals
 enroll$ 9 ! applicable plan or heal?   
insurance cov]age t su* plan or cov]age 

has be5 det]m9$ to be n 9 compliance )  
?is section4  7,b7 ,exemption f         
disclosure ,docum5ts or communications  
produc$ 9 connection ) ! ,secret>y's    
recomm5dations to a gr\p heal? plan or  
heal? insurance issu] %all n be subject 
to disclosure pursuant to section #eeb (
 title #e1 ,unit$ ,/ates ,code4  7#d7   
,report ,= plan ye>s beg9n+ on or aft]  
,janu>y #a1 #bjbf1 ! ,secret>y %all     
submit to ,congress1 & make publicly    
available1 a report t conta9s--  7,a7 a 
summ>y ( ! analysis submitt$ "u p>agraph
 7#a71 includ+ ! id5tity ( ea* gr\p     
heal? plan or heal? insurance issu] (f]+
 heal? insurance cov]age t is det]m9$ to
 be n 9 compliance aft] ! f9al          
det]m9ation by ! ,secret>y describ$ 9   
p>agraph 7#c77;,a77ii72  7,b7 !         
,secret>y's conclusions z to :e!r ea*   
gr\p heal? plan or heal? insurance issu]
 submitt$ suffici5t in=mation = !       
,secret>y to review ! analysis "u       
p>agraph 7#b72  7,c7 = ea* gr\p heal?   
plan or heal? insurance issu] t did     

submit suffici5t in=mation "u p>agraph  
7#b71 ! ,secret>y's conclusions z to    
:e!r & :y ! plan or issu] is 9          
compliance ) ! requirem5ts "u ?is       
section2  7,d7 ! ,secret>y's            
specifications describ$ 9 p>agraph 7#c7 
= ea* gr\p heal? plan or heal? insurance
 issu] t ! ,secret>y det]m9$ did n      
submit suffici5t in=mation = ! ,secret>y
 to review ! analyses describ$ 9        
p>agraph 7#a7 = compliance ) ?is        
section2 &  7,e7 ! actions ! ,secret>y  
specifies "u p>agraph 7#c77;,a77i7 t ea*
 gr\p heal? plan or heal? insurance     
issu] t ! ,secret>y det]m9$ is n 9      
compliance ) ?is section is requir$ take
 to be 9 compliance ) ?is section1      
includ+ ! reason :y ! ,secret>y det]m9$ 
! plan or issu] is n 9 compliance4  7h7 
,notice ,beg9n+ ) ! second plan ye>     
beg9n+ aft] ! date ( enactm5t ( ! ,help+
 to ,optimize ,pati5ts' ,exp]i5ce )     
,f]tility ,s]vices ,act1 a gr\p heal?   
plan & a heal? insurance issu] (f]+ gr\p
 heal? insurance cov]age %all provide   

notice to p>ticipants & b5efici>ies 9   
su* plan or cov]age reg>d+ ! cov]age    
requir$ by ?is section 9 accordance )   
regulations promulgat$ by ! ,secret>y4  
7i7 ,effective date ,?is section1 & !   
am5dm5ts made by ?is section1 %all apply
 ) respect to plan ye>s beg9n+ on or    
aft] ,janu>y #a1 #bjbf4  4  7b7         
,en=cem5t ,section #ejb ( ! ,employee   
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aacb7 is am5d$--  
7#a7 9 subsection 7a77#f71 by /rik+ or  
7#i7 & ins]t+ 7#i71 or 7#ac72  7#b7 9   
subsection 7b77#c71 by /rik+ subsection 
7c77#i7 & ins]t+ p>agraphs 7#i7 & 7#ac7 
( subsection 7c72 &  7#c7 9 subsection  
7c71 by add+ at ! end ! foll[+3  7#ac7  
7,a7 ,! ,secret>y may assess a civil    
p5alty aga9/ a heal? insurance issu] =  
fail+ to provide cov]age = inf]tility or
 iatrog5ic inf]tility treatm5ts z       
requir$ "u section #gad;,a1 9 an am\nt  
up to #ajj p] day1 beg9n+ on ! date on  
:i* ! issu] fir/ d5ies su* cov]age &    
end+ on ! date on :i* ! issu] approves  

cov]age1 ) respect to ea* p>ticipant or 
b5efici>y d5i$ su* cov]age 9 violation (
 su* section4  7,b7 ,! ,secret>y may    
assess a civil p5alty aga9/ a heal?     
insurance issu] = fail+ to submit an    
analysis z requir$ "u section           
#gad;,a7g77#b71 9 an am\nt up to #ajj = 
ea* day1 beg9n+ #de days aft] ! date on 
:i* ! ,secret>y notifies su* issu] t !  
issu] is n 9 compliance ) ! requirem5t  
"u section #gad;,a7g77#b71 & end+ on !  
date on :i* ! issue submits ! analysis z
 requir$4  4  7c7 ,con=m+ am5dm5t       
,section #gca7;c7 ( ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aaia7;c77 is am5d$
 by /rik+ section #gaa & ins]t+ sections
 #gaa & #gad;,a4