,i #aaith ,,congress #ast ,session ,h4 ,r4 #cdhj ,,in ,,the ,,house ,,of ,,representatives ,may #ai1 #bjbe,ms4 ,underwood introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend the ,patient ,protection and ,affordable ,care ,act to include fertility treatment and care as an essential health benefit4 #a4 ,short title ,this ,act may be cited as the ,health ,coverage for ,inclusive and ,valued ,families ,act of #bjbe or the ,health ,coverage for ,,ivf ,act of #bjbe4 #b4 ,including fertility treatment and care as an essential health benefit 7a7 ,in general ,section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking paragraph 7#b7 and inserting paragraphs 7#b7 and 7#f72 and 7,b7 by adding at the end the following new subparagraph3 7,k7 ,fertility treatment and care4 2 and 7#b7 by adding at the end the following new paragraph3 7#f7 ,fertility treatment and care defined ,for purposes of paragraph 7#a77,k71 the term fertility treatment and care means the following medically appropriate items and services furnished to an individual3 7,a7 ,preservation of human oocytes1 sperm1 or embryos for later reproductive use4 7,b7 ,artificial insemination1 including intravaginal insemination1 intracervical insemination1 and intrauterine insemination4 7,c7 ,assisted reproductive technology1 including in vitro fertilization and other treatments or procedures in which reproductive genetic material1 such as oocytes1 sperm1 fertilized eggs1 and embryos1 are handled1 when clinically appropriate1 and including at least #c complete oocyte retrievals and an unlimited number of embryo transfers from such retrievals 7regardless of whether such retrieval was performed on1 before1 or after the date of the enactment of this paragraph7 in accordance with the guidelines of the ,american ,society for ,reproductive ,medicine and using single embryo transfer when recommended and medically appropriate4 7,d7 ,genetic testing of embryos4 7,e7 ,medications prescribed1 as indicated for fertility4 7,f7 ,gamete donation4 7,g7 ,such other information1 referrals1 treatments1 procedures1 medications1 laboratory testing1 technologies1 and services relating to fertility as the ,secretary determines appropriate4 4 7b7 ,additional requirements ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following new section3 #bgcj4 ,requirements relating to fertility treatment and care 7a7 ,in general ,in the case of health insurance coverage offered in the individual or small group market that provides both medical and surgical benefits and benefits for fertility treatment and care 7as defined in section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act71 such coverage shall ensure that-- 7#a7 the financial requirements applicable to such fertility treatment and care benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the coverage1 and there are no separate cost sharing requirements that are applicable only with respect to fertility treatment and care benefits2 and 7#b7 the treatment limitations applicable to such fertility treatment and care benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the coverage and there are no separate treatment limitations that are applicable only with respect to fertility treatment and care benefits4 7b7 ,prohibition on denial of care ,a health insurance issuer offering health insurance coverage in the individual or small group market may not deny benefits for fertility treatment and care for individual on the basis that such individual lacks a diagnosis of infertility4 7c7 ,utilization management tools 7#a7 ,in general ,a health insurance issuer offering health insurance coverage in the individual or small group market that imposes any utilization management tool with respect to fertility treatment and care shall1 for each of the first #e plan years beginning on or after the date that is #a year after the date of the enactment of this ,act 7and1 upon request of the ,secretary or the ,comptroller ,general of the ,united ,states1 for any subsequent plan year71 conduct an analysis of the application of any such tool to such treatment and care and submit such analysis to the ,secretary and to the ,comptroller ,general of the ,united ,states4 ,such analysis shall contain the following information3 7,a7 ,the specific coverage terms or other relevant terms regarding the application of such tools to such benefits and a description of all such benefits4 7,b7 ,the factors used to determine when utilization management tools apply to such benefits4 7,c7 ,the evidentiary standards used in designing the application of such tools with respect to such benefits and any other source or evidence used to determine the application of such tools to such benefits4 7,d7 ,information demonstrating how application of such tools to such benefits are consistent with clinical guidelines for fertility treatment and care4 7,e7 ,any findings by the issuer that such coverage is not in compliance with this section4 7#b7 ,report ,for plan years beginning on or after the date that is #a year after the date of the enactment of this section1 the ,comptroller ,general of the ,united ,states shall submit to ,congress and make publicly available a report that contains the following3 7,a7 ,a summary of the analyses submitted under paragraph 7#a7 with respect to such plan year4 7,b7 ,an identification of each health insurance issuer that failed to submit an analysis under paragraph 7#a74 7,c7 ,with respect to each health insurance issuer that did submit such an analysis1 a specification as to whether such issuer submitted information sufficient to determine whether such issuer was in compliance with such requirements4 7,d7 ,for each health insurance issuer that did submit information sufficient to determine such compliance1 a finding of whether such issuer was in compliance with such requirements4 7d7 ,definitions ,the terms financial requirement1 predominant1 and treatment limitation have the meaning given such terms in section #bgbf7;a77#c74 4 7c7 ,effective date ,the amendments made by this section shall apply to plan years beginning on or after the date that is #a year after the date of the enactment of this ,act4