,,ii  #aai? ,,congress  #b;d ,session   
,s4 #eajh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bc1 #bjbf,ms4   
,duckwor? 7= h]self1 ,mrs4 ,murray1 ,mr4
 ,book]1 ,mr4 ,s*um]1 ,ms4 ,alsobrooks1 
,ms4 ,baldw91 ,mr4 ,b5net1 ,mr4         
,blum5?al1 ,ms4 ,blunt ,ro*e/]1 ,ms4    
,cantwell1 ,mr4 ,coons1 ,ms4 ,cortez    
,ma/o1 ,mr4 ,durb91 ,mr4 ,fett]man1 ,mr4
 ,gallego1 ,mrs4 ,gillibr&1 ,ms4        
,hassan1 ,mr4 ,he9ri*1 ,mr4 ,hick5loop]1
 ,ms4 ,hirono1 ,mr4 ,ka9e1 ,mr4 ,kelly1 
,mr4 ,kim1 ,mr4 ,k+1 ,ms4 ,klobu*>1 ,mr4
 ,lujn1 ,mr4 ,m>key1 ,mr4 ,m]kley1 ,mr4 
,murphy1 ,mr4 ,oss(f1 ,mr4 ,padilla1    
,mr4 ,pet]s1 ,mr4 ,re$1 ,ms4 ,ros51 ,mr4
 ,s&]s1 ,mr4 ,s*atz1 ,mr4 ,s*iff1 ,mrs4 
,%ahe51 ,ms4 ,slotk91 ,ms4 ,smi?1 ,mr4  
,van ,holl51 ,mr4 ,w>n]1 ,mr4 ,w>nock1  
,ms4 ,w>r51 ,mr4 ,wel*1 ,mr4 ,:iteh\se1 
& ,mr4 ,wyd57 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions  ,a ,,bill  ,to      
protect & exp& nationwide access to     

assi/$ reproductive te*nology1 includ+ 9
 vitro f]tilization4  #a4 ,%ort title2  
table ( cont5ts  7a7 ,%ort title ,?is   
,act may be cit$ z ! ,"r to ,,ivf ,act (
 #bjbf4  7b7 ,table ( cont5ts ,! table (
 cont5ts = ?is ,act is z foll[s3 ,sec4  
#a4 ,%ort title2 table ( cont5ts4,sec4  
#b4 ,sev]ability4,,title ,i--,protect   
,i,v,f,sec4 #aja4 ,%ort title4,sec4     
#ajb4 ,purposes4,sec4 #ajc4             
,def9itions4,sec4 #ajd4 ,assi/$         
reproductive te*nology rights &         
intraut]9e insem9ation rights4,sec4     
#aje4 ,applicability &                  
preemption4,,title ,,ii--,vet]an        
,families ,heal? ,services,sec4 #bjj4   
,%ort title4,subtitle ,a--,reproductive 
& f]tility pres]vation assi/ance =      
memb]s ( ! uni=m$ services,sec4 #bja4   
,def9itions4,sec4 #bjb4 ,provision (    
assi/$ reproductive te*nology1          
intraut]9e insem9ation1 & c\nsel+ to    
c]ta9 memb]s ( ! uni=m$ s]vices &       
sp\ses1 p>tn]s1 & ge/ational surrogates 
( su* memb]s4,sec4 #bjc4 ,e/abli%m5t (  

f]tility pres]vation proc$ures = memb]s 
( ! uni=m$ s]vices on active duty4,sec4 
#bjd4 ,assi/ance ) & cont9uity ( c>e    
reg>d+ reproductive & f]tility          
pres]vation s]vices4,sec4 #bje4         
,coord9ation betwe5 ,dep>tm5t ( ,def5se 
& ,dep>tm5t ( ,vet]ans ,affairs on      
furni%+ ( assi/$ reproductive te*nology1
 intraut]9e insem9ation1 & c\nsel+4,sec4
 #bjf4 ,regulations4,subtitle           
,b--,reproductive assi/ance =           
veterans,sec4 #baa4 ,inclusion ( assi/$ 
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ "u ! def9ition ( 
m$ical s]vices 9 title #ch4,sec4 #bab4  
,assi/$ reproductive te*nology1         
intraut]9e insem9ation1 & c\nsel+ =     
c]ta9 vet]ans & sp\ses1 p>tn]s1 &       
ge/ational surrogates ( su*             
vet]ans4,sec4 #bac4 ,assi/ance ) &      
cont9uity ( c>e reg>d+ reproductive &   
f]tility pres]vation s]vices4,sec4 #bad4
 ,coord9ation ( reproduction & f]tility 
rese>* = vet]ans4,,title ,,iii--,access 
to assi/$ reproductive te*nology &      

intraut]9e insemination,sec4 #cja4 ,%ort
 title4,sec4 #cjb4 ,/&>ds relat+ to     
b5efits = assi/$ reproductive te*nology 
& intraut]9e insem9ation4,sec4 #cjc4    
,requirem5t = ,/ate ,m$icaid plans to   
provide m$ical assi/ance = assi/$       
reproductive te*nology & intraut]9e     
insem9ation4,sec4 #cjd4 ,m$ic>e cov]age 
( assi/$ reproductive te*nology &       
intraut]9e insem9ation4,,title          
,,iv--,family build+ ,,fehb             
fairness,sec4 #dja4 ,%ort title4,sec4   
#djb4 ,assi/$ reproductive te*nology &  
intraut]9e insem9ation b5efits4  #b4    
,sev]ability ,if any provision ( ?is    
,act1 or ! application ( su* provision  
to any p]son1 entity1 gov]nm5t1 or      
circum/ance is held to be               
uncon/itutional1 ! rema9d] ( ?is ,act1  
or ! application ( su* provision to all 
o!r p]sons1 entities1 gov]nm5ts1 or     
circum/ances %all n be affect$ !reby4   
,i ,protect ,,ivf  #aja4 ,%ort title    
,?is title may be cit$ z ! ,protect     
,,ivf ,act4  #ajb4 ,purposes ,! purposes

 ( ?is title are z foll[s3 7#a7 ,to     
p]mit pati5ts to seek & receive assi/$  
reproductive te*nology 7,,art71 includ+ 
9 vitro f]tilization 7,,ivf71 &         
intraut]9e insem9ation 7,,iui71 & to    
p]mit heal? c>e provid]s t *oose to     
provide ,,art or ,,iui to provide su*   
s]vices1 by ensur+ t ,/ates w n enact   
h>mful or unw>rant$ limitations or      
requirem5ts t s+le out ! provision (    
,,art or ,,iui = re/rictions t are n    
consi/5t ) ,am]ican ,society =          
,reproductive ,m$ic9e guidel9es & t d n 
significantly advance reproductive heal?
 or ! efficacy & safety ( ,,art or      
,,iui1 or t make ,,art or ,,iui m       
difficult to access4  7#b7 ,to promote !
 "r & ability ( an individual resid+ 9  
any ,/ate to *oose to receive ,,art or  
,,iui provid$ by a heal? c>e provid] :o 
*ooses to provide su* s]vices4  7#c7 ,to
 protect an individual's "r to make     
decisions1 9 consultation ) !           
individual's heal? c>e provid]1 ab\t !  
mo/ appropriate m$ical c>e to maximize !

 *ance ( becom+ pregnant & giv+ bir? to 
a heal?y1 liv+1 human *ild ) ! help (   
,,art or ,,iui4  #ajc4 ,def9itions ,9   
?is title3 7#a7 ,assi/$ reproductive    
te*nology2 ,,art ,! t]m assi/$          
reproductive te*nology or ,,art means   
any treatm5t or proc$ure t includes !   
h&l+ ( human eggs or embryos to help    
a*ieve a pregnancy1 includ+ 9 vitro     
f]tilization1 egg or embryo             
cryopres]vation1 & egg or embryo        
donation4 ,su* t]m includes any         
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#b7 ,heal? c>e provid] ,!   
t]m heal? c>e provid] means any entity  
or individual 7includ+ any physician1   
nurse practition]1 physician assi/ant1  
ph>maci/1 heal? c>e support p]sonnel1 or
 cl9ical /aff7 t-- 7,a7 is engag$ or    
seeks to engage 9 ! deliv]y ( ,,art or  
,,iui1 includ+ ?r\gh ! provision (      
evid5ce-bas$ in=mation1 c\nsel+1        
ref]rals1 or items & s]vices t relate   
to1 aid 91 or provide ,,art or ,,iui2 & 
7,b7 if requir$ by ,/ate law to be      

lic5s$1 c]tifi$1 or o!rwise au?oriz$ to 
engage 9 ! deliv]y ( ,,art or ,,iui--   
7i7 is s lic5s$1 c]tifi$1 or o!rwise    
au?oriz$2 or  7ii7 w\ld be s lic5s$1    
c]tifi$1 or o!rwise au?oriz$ b = ! fact 
t ! individual or entity has provid$1 is
 provid+1 or plans to provide1 ,,art or 
,,iui 9 accordance ) section #ajd4  7#c7
 ,heal? insurance issu] ,! t]m heal?    
insurance issu] has ! mean+ giv5 su* t]m
 9 section #bgia7;b7 ( ! ,public ,heal? 
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ia7;b774  7#d7 ,intraut]9e     
insem9ation2 ,,iui ,! t]m intraut]9e    
insem9ation or ,,iui means a proc$ure t 
places sp]m directly into an            
individual's ut]us at ! "t ( !          
individual's ovulation to increase !    
*ances ( f]tilization4 ,su* t]m includes
 any m$ication associat$ ) su* a        
proc$ure4  7#e7 ,manufactur] ,! t]m     
manufactur] means ! manufactur] ( a drug
 or device approv$1 cle>$1 au?oriz$1 or 
lic5s$ "u section #eje1 #eaj7k71        
#eac7;f77#b71 or #eae ( ! ,f$]al ,food1 

,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4  
#cee1 #cfj7k71 #cfj;c7f77#b71 #cfj;e7 or
 section #cea ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #bfb71 or o!rwise  
legally m>ket$4  7#f7 ,/ate ,! t]m ,/ate
 includes ea* ( ! #ej ,/ates1 ! ,di/rict
 ( ,columbia1 ea* t]ritory & possession 
( ! ,unit$ ,/ates1 & any political      
subdivision !re(4  #ajd4 ,assi/$        
reproductive te*nology rights &         
intraut]9e insem9ation rights  7a7      
,g5]al rule  7#a7 ,individual rights ,an
 individual has a /atutory "r "u ?is    
title1 )\t prohibition1 limitation1     
int]f]5ce1 or imp$im5t1 to ! ext5t t su*
 prohibition1 limitation1 int]f]5ce1 or 
imp$im5t 9 any way or degree ob/ructs1  
delays1 or affects comm]ce ov] :i* !    
,f$]al ,gov]nm5t has jurisdiction1 to-- 
7,a7 receive ,,art or ,,iui f a heal?   
c>e provid]2  7,b7 cont9ue or complete  
an ongo+ ,,art or ,,iui s]vice previ\sly
 initiat$ by a heal? c>e provid]2  7,c7 
make decisions & arrangem5ts reg>d+ !   
donation1 te/+1 use1 /orage1 or         

disposition ( reproductive g5etic       
mat]ial1 su* z oocytes1 sp]m1 f]tiliz$  
eggs1 & embryos2 &  7,d7 e/abli%        
contractual agreem5ts ) a heal? c>e     
provid] relat+ to ! heal? c>e provid]'s 
s]vices 9 h&l+1 te/+1 /or+1 %ipp+1 &    
dispos+ ( ! individual's reproductive   
g5etic mat]ial4  7#b7 ,heal? c>e provid]
 rights ,a heal? c>e provid] has a      
/atutory "r "u ?is title1 )\t           
prohibition1 limitation1 int]f]5ce1 or  
imp$im5t1 to ! ext5t t su* prohibition1 
limitation1 int]f]5ce1 or imp$im5t 9 any
 way or degree ob/ructs1 delays1 or     
affects comm]ce ov] :i* ! ,f$]al        
,gov]nm5t has jurisdiction1 to-- 7,a7   
provide1 or assi/ ) ! provision (1 ,,art
 or ,,iui2  7,b7 cont9ue or complete !  
provision (1 or assi/ance )1 ,,art or   
,,iui t 0 lawful :5 comm5c$2  7,c7      
provide =1 or assi/ )1 ! te/+1 use1     
/orage1 or disposition ( reproductive   
g5etic mat]ial1 su* z oocytes1 sp]m1    
f]tiliz$ eggs1 & embryos2 &  7,d7       
e/abli% contractual agreem5ts )         

individuals or manufactur]s relat+ to ! 
heal? c>e provid]'s s]vices 9 h&l+1     
te/+1 /or+1 %ipp+1 & dispos+ ( !        
individual's reproductive g5etic        
mat]ial4  7#c7 ,heal? insurance issu]   
rights ,a heal? insurance issu] has a   
/atutory "r "u ?is title1 )\t           
prohibition1 limitation1 int]f]5ce1 or  
imp$im5t1 to ! ext5t t su* prohibition1 
limitation1 int]f]5ce1 or imp$im5t 9 any
 way or degree ob/ructs1 delays1 or     
affects comm]ce ov] :i* ! ,f$]al        
,gov]nm5t has jurisdiction1 to cov] !   
provision ( ,,art or ,,iui4  7#d7       
,manufactur] rights ,a manufactur] ( a  
drug or device t is approv$1 cle>$1     
au?oriz$1 or lic5s$ "u section #eje1    
#eaj7k71 #eac7;f77#b71 or #eae ( !      
,f$]al ,food1 ,drug1 & ,cosmetic ,act   
7#ba ,u4,s4,c4 #cee2 #cfj7k72           
#cfj;c7f77#b72 #cfj;e7 or section #cea (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #bfb7 or o!rwise legally      
m>ket$ & int5d$ = use 9 ! provision (   
,,art or ,,iui1 includ+ ! /orage or     

transport ( oocytes1 gametes1 f]tiliz$  
eggs1 & embryos1 has a /atutory "r "u   
?is title1 )\t prohibition1 limitation1 
int]f]5ce1 or imp$im5t1 to ! ext5t t su*
 prohibition1 limitation1 int]f]5ce1 or 
imp$im5t 9 any way or degree ob/ructs1  
delays1 or affects comm]ce ov] :i* !    
,f$]al ,gov]nm5t has jurisdiction1 to   
manufacture1 import1 m>ket1 sell1 &     
di/ribute su* drug or device4  7b7 ,/ate
 regulation ( m$ic9e ,! en=cem5t ( ,/ate
 heal? & safety law reg>d+ m$ical       
facilities or heal? c>e provid]s does n 
con/itute a violation ( subsection 7a7  
if-- 7#a7 su* regulations are consi/5t )
 guidance f ! ,am]ican ,society =       
,reproductive ,m$ic9e = provid+ ,,art or
 ,,iui2 &  7#b7 ! safety or heal?       
objective _c be advanc$ by a diff]5t    
means t does n prohibit1 limit1 int]f]e 
)1 or imp$e ! rights describ$ 9         
subsection 7a74  7c7 ,en=cem5t  7#a7 ,! 
attorney g5]al  7,a7 ,9 g5]al ,!        
,attorney ,g5]al may comm5ce a civil    
action on behalf ( ! ,unit$ ,/ates aga9/

 any ,/ate2 an individual1 employee1    
(ficial1 ag5cy head1 contractor1        
organization1 or in/rum5tality act+ =1  
or on behalf (1 su* a ,/ate2 or any     
individual act+ "u ! color (1 or        
pursuant to1 ,/ate law1 t implem5ts1    
en=ces1 or ?reat5s to en=ce a limitation
 or requirem5t t prohibits1 limits1     
int]f]es )1 or imp$es ! /atutory rights 
( an individual1 a heal? c>e provid]1 a 
heal? insurance issu]1 or a manufactur] 
"u subsection 7a74  7,b7 ,effect (      
violations ,! c\rt %all hold unlawful & 
set aside a limitation or requirem5t    
describ$ 9 subp>agraph 7,a7 if x is 9   
violation ( subsection 7a74  7#b7       
,private "r ( action  7,a7 ,9 g5]al ,any
 individual or entity adv]sely affect$  
by an alleg$ violation ( subsection 7a7 
may comm5ce a civil action aga9/ an     
individual1 employee1 (ficial1 ag5cy    
head1 contractor1 organization1 or      
in/rum5tality act+ =1 or on behalf (1   
su* a ,/ate t enacts1 implem5ts1 or     
en=ces a limitation or requirem5t t     

prohibits1 limits1 int]f]es )1 or imp$es
 ! /atutory rights ( an individual1 a   
heal? c>e provid]1 a heal? insurance    
issu]1 or a manufactur] "u subsection   
7a74  7,b7 ,effect ( violations ,! c\rt 
%all hold unlawful & enjo9 a limitation 
or requirem5t describ$ 9 subp>agraph    
7,a7 if x is 9 violation ( subsection   
7a74  7#c7 ,heal? c>e provid]  7,a7 ,9  
g5]al ,a heal? c>e provid] may comm5ce a
 civil action = relief on su* provid]'s 
own behalf1 on behalf ( ! provid]'s     
/aff1 or on behalf ( ! provid]'s pati5ts
 :o are or may be adv]sely affect$ by an
 alleg$ violation ( subsection 7a74     
7,b7 ,effect ( violations ,! c\rt %all  
hold unlawful & enjo9 a limitation or   
requirem5t describ$ 9 subp>agraph 7,a7  
if x is 9 violation ( subsection 7a74   
7#d7 ,equitable relief ,9 any action "u 
?is section1 ! c\rt may aw>d appropriate
 equitable relief1 includ+ tempor>y1    
prelim9>y1 or p]man5t injunctive relief4
  7#e7 ,co/s  7,a7 ,9 g5]al ,9 any      
action "u ?is section1 ! c\rt %all aw>d 

co/s ( litigation1 z well z reasonable  
attorney's fees1 to any prevail+        
pla9tiff4  7,b7 ,liability ( pla9tiffs  
,a pla9tiff %all n be liable to a       
def5dant = co/s or attorney's fees 9 any
 non-frivol\s action "u ?is section     
unless su* co/s or attorney's fees are  
impos$ by ! c\rt z "p ( sanctions =     
violations committ$ dur+ ! discov]y     
process4  7#f7 ,jurisdiction ,! di/rict 
c\rts ( ! ,unit$ ,/ates %all h          
jurisdiction ov] proce$+s "u ?is section
 & %all ex]cise ! same )\t reg>d to :e!r
 ! p>ty aggriev$ %all h exhau/$ any     
adm9i/rative or o!r rem$ies t may be    
provid$ = by law4  7#g7 ,"r to remove   
7,a7 ,9 g5]al ,any p>ty %all h a "r to  
remove an action br\ght "u ?is          
subsection to ! di/rict c\rt ( ! ,unit$ 
,/ates = ! di/rict & division embrac+ ! 
place :]e su* action is p5d+4  7,b7     
,review ,an ord] rem&+ ! case to ! ,/ate
 c\rt f :i* x 0 remov$ "u ?is p>agraph  
is imm$iately reviewable by appeal or   
o!rwise4  7d7 ,regulations ,n lat] ?an  

#ahj days aft] ! date ( enactm5t ( ?is  
,act1 ! ,secret>y ( ,heal? & ,human     
,s]vices %all promulgate regulations to 
c>ry out ?is section4  7e7 ,rules (     
con/ruction  7#a7 ,9 g5]al ,= purposes (
 ?is title1 a ,/ate law1 or !           
adm9i/ration1 implem5tation1 or en=cem5t
 ( a ,/ate law1 con/itutes a            
prohibition1 limitation1 int]f]5ce1 or  
imp$im5t on a heal? c>e provid] provid+1
 an individual receiv+1 a heal?         
insurance issu] cov]+1 or a manufactur] 
m>ket+ drugs or devices = ,,art or      
,,iui1 z describ$ 9 ?is section1 if !   
adm9i/ration1 implem5tation1            
int]pretation1 or en=cem5t ( su* law has
 an effect t-- 7,a7 imposes requirem5ts 
or limitations t are inconsi/5t )       
provid+1 receiv+1 provid+ heal?         
insurance cov]age =1 or provid+ drugs or
 devices = ,,art or ,,iui or t o!rwise  
violate ! purpose & requirem5ts ( ?is   
,act1 :i* may include-- 7i7 requir+ t a 
heal? c>e provid] provide1 & pati5ts    
und]take1 m$ically unnecess>y proc$ures 

& s]vices1 includ+ te/s & proc$ures1    
provid+ m$ically inaccurate in=mation   
reg>d+ ,,art or ,,iui1 or requir+       
additional unnecess>y 9-p]son visits to 
a heal? c>e provid]2  7ii7 impos+       
limitations or requirem5ts conc]n+      
physical (fices1 cl9ics1 facilities1    
equipm5t1 /aff+1 or hospital transf]    
arrangem5ts ( facilities :]e ,,art or   
,,iui are provid$1 or ! cr$5tials or    
hospital privileges or /atus ( p]sonnel 
at su* facilities2 or  7iii7 limit+ a   
heal? c>e provid]'s "r or ability to    
provide1 or a pati5t's "r to receive1   
cont9ue or complete ,,art or ,,iui1 or  
impos+ limitations t r$uce ! efficacy (1
 ,,art or ,,iui1 includ+ limitations    
on-- 7,i7 retrieval ( multiple eggs dur+
 oocyte retrieval2  7,,ii7              
intracytoplasmic sp]m injections to     
f]tilize multiple human eggs2 &  7,,iii7
 cryopres]vation ( "o or m eggs1 sp]m1  
or embryos if det]m9$ appropriate by !  
heal? c>e provid] & pati5t2  7,b7       
infr+es1 limits1 or re/ricts ! ability (

 a heal? c>e provid]1 pati5t1 heal?     
insurance issu]1 or manufactur]1 to     
ex]cise or en=ce _! /atutory rights "u  
?is title on ! basis ( m>ital /atus1 sex
 7includ+ sexual ori5tation & g5d]      
id5tity7 or any o!r protect$ class t is 
cov]$ by ,f$]al law2  7,c7 limits a     
heal? c>e provid]'s or pati5t's "r or   
ability to det]m9e ! mo/ appropriate    
disposition ( reproductive g5etic       
mat]ial1 includ+ by def9+ a gamete or   
embryo 9 su* a way to limit an          
individual's options = h[ _!            
reproductive g5etic mat]ial %\ld be     
h&l$2  7,d7 limits a heal? c>e provid]'s
 ability to provide1 or a pati5t's      
ability to receive1 ,,art or ,,iui via  
telem$ic9e2  7,e7 limits or prohibits a 
heal? c>e provid]'s ability to provide1 
or a pati5t's ability to receive1       
c\nsel+ reg>d+ ,,art or ,,iui bas$ on ! 
resid5cy ( ! pati5t1 or prohibits or    
limits ! ability ( any individual to    
assi/ or support a pati5t seek+ ,,art or
 ,,iui2  7,f7 imposes requirem5ts or    

limitations t compel heal? c>e provid]s 
to provide1 or pati5ts to receive1      
m$ically unnecess>y c>e1 or )hold       
m$ically necess>y c>e1 includ+ m&at+ !  
transf] ( embryos t a heal? c>e provid] 
w\ld n reasonably expect1 bas$ on       
,am]ican ,society = ,reproductive       
,m$ic9e guidel9es1 to lead to a         
pregnancy or a live bir?2 or  7,g7      
limits a heal? c>e provid]'s "r or      
ability to prescribe or disp5se1 or a   
pati5t's "r or ability to receive or    
use1 m$ications = ,,art or ,,iui1 unless
 su* a limitation is g5]ally applicable 
to ! prescription1 disp5s+1 or          
di/ribution ( m$ications4  7#b7         
,cl>ification ,! descriptions ( specific
 ,/ate laws t w\ld violate ! /atutory   
rights & protections describ$ 9 p>agraph
 7#a7 %all n be con/ru$ to limit        
pot5tial violations ( ! /atutory rights 
& protections "u ?is title to only !    
re/rictions & limitations li/$ 9        
p>agraph 7#a71 & pot5tial violations (  
?is title may result f novel ,/ate      

re/rictions & limitations t are n li/$  
"u p>agraph 7#a74  7#c7 ,exclusion ,x   
%all n con/itute a prohibition1         
limitation1 int]f]5ce1 or imp$im5t to a 
heal? c>e provid] provid+1 an individual
 receiv+1 a heal? insurance issu] cov]+1
 or a manufactur] m>ket+ a drug or      
device = purposes (1 ,,art or ,,iui "u  
?is title = an entity to act 9          
compliance ) ! ,food & ,drug            
,adm9i/ration's regulation ( drugs1     
devices1 biological products1 human     
cells1 tissues1 or cellul> or           
tissue-bas$ products us$ 9 ,,art or     
,,iui4  #aje4 ,applicability &          
preemption  7a7 ,9 g5]al  7#a7 ,g5]al   
application  7,a7 ,effect on ,/ate law  
,?is title sup]s$es any ,/ate law t is  
inconsi/5t ) ! /atutory rights e/abli%$ 
"u ?is title & precludes ! implem5tation
 ( su* a law1 :e!r /atutory1 common law1
 or o!rwise1 & :e!r adopt$ be=e or aft] 
! date ( enactm5t ( ?is ,act4  7,b7     
,prohibition ,no ,/ate %all adm9i/]1    
implem5t1 or en=ce any law1 rule1       

regulation1 /&>d1 or o!r provision hav+ 
! =ce & effect ( law t conflicts ) any  
provision ( ?is title1 not)/&+ any o!r  
provision ( ,f$]al law4  7#b7 ,exclusion
 ,preemption ( ,/ate law "u p>agraph    
7#a7 does n apply to-- 7,a7 ,/ate law   
reg>d+ ! resolution ( disputes betwe5 #b
 individuals ) rights describ$ 9 section
 #ajd7;a77#a7 ) respect to ! same       
reproductive g5etic mat]ial1 su* z      
oocytes1 sp]m1 f]tiliz$ eggs1 & embryos2
 or  7,b7 any o!r ,/ate law1 to ! ext5t 
t su* law does n conflict ) ?is title & 
protects an individual's "r & ability to
 receive ,,art or ,,iui 9 accordance )  
,am]ican ,society = ,reproductive       
,m$ic9e guidel9es1 includ+ any su* law t
 holds a heal? c>e provid] acc\ntable = 
n provid+ ,,art or ,,iui 9 accordance ) 
su* guidel9es4  7#c7 ,pres]vation (     
,f$]al public heal? au?orities ,no?+ 9  
?is title %all h ! effect ( sup]s$+1    
negat+1 or limit+ provisions ( ,f$]al   
law1 includ+ ! ,f$]al ,food1 ,drug1 &   
,cosmetic ,act 7#ba ,u4,s4,c4 #cja et   

seq47 or ! ,public ,heal? ,s]vice ,act  
7#db ,u4,s4,c4 #bja et seq471 &         
regulations promulgat$ "u su* /atutes1 )
 respect to ! regulation ( drugs1       
devices1 biological products1 human     
cells1 tissues1 or cellul> or           
tissue-bas$ products us$ 9 ,,art or     
,,iui4  7#d7 ,pres]vation ( ,,hipaa     
rules ,no?+ 9 ?is title %all h ! effect 
( sup]s$+1 negat+1 or limit+ !          
provisions ( ! privacy1 security1 &     
brea* notification regulations 9 p>ts   
#afj & #afd ( title #de1 ,code ( ,f$]al 
,regulations 7or successor regulations74
  7#e7 ,subsequ5tly enact$ ,f$]al       
legislation ,f$]al /atutory law adopt$  
aft] ! date ( ! enactm5t ( ?is ,act is  
subject to ?is title unless su* law     
explicitly excludes su* application by  
ref]5ce to ?is title4  7b7 ,def5se ,9   
any cause ( action aga9/ an individual  
or entity :o is subject to a limitation 
or requirem5t t violates ?is title1 9   
addition to ! rem$ies specifi$ 9 section
 #ajd7;c71 ?is title %all also apply to1

 & may be rais$ z a def5se by1 su* an   
individual or entity4  ,,ii ,vet]an     
,families ,heal? ,s]vices  #bjj4 ,%ort  
title ,?is title may be cit$ z ! ,vet]an
 ,families ,heal? ,s]vices ,act4  ,a    
,reproductive & f]tility pres]vation    
assi/ance = memb]s ( ! uni=m$ s]vices   
#bja4 ,def9itions ,9 ?is subtitle3 7#a7 
,active duty ,! t]m active duty has !   
mean+ giv5 t t]m 9 section #aja7ah7 (   
title #cg1 ,unit$ ,/ates ,code4  7#b7   
,assi/$ reproductive te*nology ,! t]m   
assi/$ reproductive te*nology means any 
treatm5t or proc$ure t includes ! h&l+ (
 human eggs or embryos to help a*ieve a 
pregnancy1 includ+ 9 vitro f]tilization1
 egg or embryo cryopres]vation1 & egg or
 embryo donation4 ,su* t]m includes any 
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#c7 ,intraut]9e insem9ation 
,! t]m intraut]9e insem9ation means a   
proc$ure t places sp]m directly into an 
individual's ut]us at ! "t ( !          
individual's ovulation to increase !    
*ances ( f]tilization4 ,su* t]m includes

 any m$ication associat$ ) su* a        
proc$ure4  7#d7 ,uni=m$ s]vices ,! t]m  
uni=m$ s]vices has ! mean+ giv5 t t]m 9 
section #aja7;a77#e7 ( title #aj1 ,unit$
 ,/ates ,code4  #bjb4 ,provision (      
assi/$ reproductive te*nology1          
intraut]9e insem9ation1 & c\nsel+ to    
c]ta9 memb]s ( ! uni=m$ s]vices &       
sp\ses1 p>tn]s1 & ge/ational surrogates 
( su* memb]s  7a7 ,assi/$ reproductive  
te*nology & c\nsel+ & intraut]9e        
insem9ation  7#a7 ,9 g5]al ,! ,secret>y 
( ,def5se %all make available assi/$    
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ to a memb] ( !   
uni=m$ s]vices or a sp\se1 p>tn]1 or    
ge/ational surrogate ( su* a memb]4     
7#b7 ,eligibility = treatm5t & c\nsel+  
,assi/$ reproductive te*nology1         
intraut]9e insem9ation1 & c\nsel+ %all  
be furni%$ "u p>agraph 7#a7 )\t reg>d to
 ! sex1 sex *>act]i/ics1 g5d] id5tity1  
sexual ori5tation1 inf]tility diagnosis1
 or m>ital /atus ( ! memb] ( ! uni=m$   
s]vices or _! p>tn]4  7#c7 ,9 vitro     

f]tilization ,9 ! case ( 9 vitro        
f]tilization treatm5t furni%$ "u        
p>agraph 7#a71 ! ,secret>y %all furni%  
to an individual "u su* p>agraph-- 7,a7 
n m ?an ?ree complet$ oocyte retrievals2
 &  7,b7 unlimit$ embryo transf]s4  7b7 
,procurem5t ( reproductive g5etic       
mat]ial ,if a memb] ( ! uni=m$ s]vices  
is unable to provide _! reproductive    
g5etic mat]ial1 su* z oocytes1 sp]m1    
f]tiliz$ eggs1 & embryos1 = purposes (  
assi/$ reproductive te*nology or        
intraut]9e insem9ation "u subsection    
7a71 ! ,secret>y %all1 at ! election (  
su* memb]1 all[ su* memb] to receive    
assi/$ reproductive te*nology or        
intraut]9e insem9ation ) donat$         
reproductive g5etic mat]ial & pay or    
reimburse su* memb] ! reasonable co/s ( 
procur+ su* mat]ial f a donor4  7c7     
,rules ( con/ruction  7#a7 ,impact on   
exi/+ au?ority ,no?+ 9 ?is section %all 
be con/ru$ to resc9d ! au?ority ( !     
,secret>y to provide 9 vitro            
f]tilization b5efits pursuant to section

 #ajgd7;c77#d7 ( title #aj1 ,unit$      
,/ates ,code4  7#b7 ,s\rc+ ( ge/ational 
surrogate or reproductive g5etic mat]ial
 ,no?+ 9 ?is section %all be con/ru$ to 
require ! ,secret>y-- 7,a7 to f9d or    
c]tify a ge/ational surrogate = a memb] 
( ! uni=m$ s]vices or to connect a      
ge/ational surrogate ) su* a memb]2 or  
7,b7 to f9d or c]tify reproductive      
g5etic mat]ial1 su* z oocytes1 sp]m1    
f]tiliz$ eggs1 & embryos1 f a donor = a 
memb] ( ! uni=m$ s]vices or to connect  
su* a memb] ) reproductive g5etic       
mat]ial f a donor4  7d7 ,def9itions ,9  
?is section3 7#a7 ,ge/ational surrogate 
,! t]m ge/ational surrogate means an    
individual :o agrees to attempt to      
become pregnant ?r\gh 9 vitro           
f]tilization "u a ge/ational surrogacy  
agreem5t us+ gametes t are n ! gametes (
 t individual4  7#b7 ,p>tn] ,! t]m      
p>tn]1 ) respect to a memb] ( ! uni=m$  
s]vices1 means an individual select$ by 
! memb] :o agrees to be a p>5t1 ) !     
memb]1 ( a *ild born z a result ( ! use 

( any assi/$ reproductive te*nology or  
intraut]9e insem9ation "u ?is section4  
#bjc4 ,e/abli%m5t ( f]tility pres]vation
 proc$ures = memb]s ( ! uni=m$ s]vices  
on active duty  7a7 ,aft] an injury or  
illness ,! ,secret>y ( ,def5se1 act+    
?r\gh ! ,assi/ant ,secret>y ( ,def5se = 
,heal? ,affairs1 %all e/abli% proc$ures 
= ! retrieval1 cryopres]vation1 & /orage
 ( reproductive g5etic mat]ial1 su* z   
oocytes1 sp]m1 f]tiliz$ eggs1 & embryos1
 z soon z m$ically appropriate1 by !    
,dep>tm5t ( ,def5se or a private entity 
f a memb] ( ! uni=m$ s]vices 9 cases 9  
:i* ! f]tility ( su* memb] is pot5tially
 jeop>diz$ z a result ( an injury or    
illness incurr$ or aggravat$ :ile s]v+  
on active duty 9 ! uni=m$ s]vices 9 ord]
 to pres]ve ! m$ical options ( su*      
memb]4  7b7 ,prior to deploym5t or c]ta9
 assignm5ts ,! ,secret>y ( ,def5se %all 
provide memb]s ( ! uni=m$ s]vices on    
active duty 9 ! uni=m$ s]vices ) !      
opportunity to cryopres]ve & /ore _!    
reproductive g5etic mat]ial1 su* z      

oocytes1 sp]m1 f]tiliz$ eggs1 & embryos1
 at a facility ( ! ,dep>tm5t ( ,def5se  
or ( a private entity1 prior to-- 7#a7  
deploym5t to a combat zone2 or  7#b7 a  
duty assignm5t t includes a haz>d\s     
assignm5t1 includ+-- 7,a7 assignm5ts    
result+ 9 exposure to p]fluoroalkyl or  
polyfluoroalkyl sub/ances2 &  7,b7 su*  
o!r assignm5ts z det]m9$ by ! ,secret>y4
  7c7 ,p]iod ( "t  7#a7 ,9 g5]al ,!     
,secret>y %all provide = !              
cryopres]vation & /orage ( reproductive 
g5etic mat]ial ( any memb] ( ! uni=m$   
s]vices "u ?is section 9 a facility ( ! 
,dep>tm5t ( ,def5se or ( a private      
entity & ! transportation ( su* mat]ial1
 at no co/ to ! memb]1 until ! date t is
 "o ye> aft] ! retirem5t1 sep>ation1 or 
release ( ! memb] f ! uni=m$ s]vices4   
7#b7 ,notice ( options foll[+ /orage    
7,a7 ,9 g5]al ,^u ! date ( retirem5t1   
sep>ation1 or release ( any memb] :o has
 cryopres]v$ & /or$ g5etic mat]ial "u   
?is section1 ! ,secret>y %all notify su*
 memb] t ! ,dep>tm5t ( ,def5se %all     

cont9ue to provide = ! cryopres]vation &
 /orage ( reproductive g5etic mat]ial = 
"o ye> & t at ! end ( su* "o-ye> p]iod !
 reproductive g5etic mat]ial %all be    
h&l$ z direct$ by ! memb] 9 writ+4  7,b7
 ,direction by memb] ,! direction ( a   
memb] "u subp>agraph 7,a7 may be provid$
 to ! ,dep>tm5t ( ,def5se or ! private  
entity /or+ ! g5etic mat]ial 9 a cons5t 
agreem5t or simil> type ( =m sign$ by ! 
memb] prior to retrieval &              
cryopres]vation or1 if applicable1 a =m 
t has sup]s$$ ! orig9al cons5t agreem5t 
or simil> type ( =m t 0 sign$ by ! memb]
 aft] ! cryopres]vation b on or be=e !  
date t is "o ye> aft] ! retirem5t1      
sep>ation1 or release ( ! memb] f !     
uni=m$ s]vices4  7d7 ,advance m$ical    
directive & milit>y te/am5t>y in/rum5t  
,a memb] ( ! uni=m$ s]vices :o is       
eligible to cryopres]ve & /ore _!       
reproductive g5etic mat]ial "u ?is      
section mu/ complete an advance m$ical  
directive1 z def9$ 9 section #ajdd;c7b7 
( title #aj1 ,unit$ ,/ates ,code1 & a   

milit>y te/am5t>y in/rum5t1 z def9$ 9   
section #ajdd;d7b7 ( su* title1 t       
explicitly specifies :e!r su* memb]     
cons5ts to ! proc$ures describ$ 9       
subsection 7a7 & h[ any cryopres]v$ &   
/or$ reproductive g5etic mat]ial %all be
 h&l$ if su* memb] dies or o!rwise loses
 ! capacity to cons5t to ! use ( _!     
cryopres]v$ & /or$ reproductive g5etic  
mat]ial4  7e7 ,agreem5ts  7#a7          
,agreem5ts ) private entities ,to c>ry  
out ?is section1 ! ,secret>y may ent]   
into agreem5ts ) private entities t     
provide cryopres]vation1 transportation1
 & /orage s]vices = reproductive g5etic 
mat]ial4  7#b7 ,no contractual or       
liability obligation = agreem5ts betwe5 
private entities & memb]s ,! ,unit$     
,/ates %all n be-- 7,a7 consid]$ a p>ty 
to any agreem5t1 cons5t =m1 or o!r      
contractual arrangem5t or commitm5t     
betwe5 a memb] ( ! uni=m$ s]vices & a   
private entity t provides               
cryopres]vation1 transportation1 &      
/orage s]vices = reproductive g5etic    

mat]ial2 or  7,b7 responsible = !       
managem5t ( reproductive g5etic mat]ial 
cryopres]v$ or /or$ at a private entity 
pursuant to su* agreem5t1 cons5t =m1 or 
o!r contractual arrangem5t or commitm5t4
  #bjd4 ,assi/ance ) & cont9uity ( c>e  
reg>d+ reproductive & f]tility          
pres]vation s]vices ,! ,secret>y (      
,def5se %all ensure t employees ( !     
,dep>tm5t ( ,def5se assi/ memb]s ( !    
uni=m$ s]vices-- 7#a7 9 navigat+ !      
s]vices provid$ "u ?is subtitle2  7#b7 9
 f9d+ a provid] t meets ! ne$s ( su*    
memb]s ) respect to su* s]vices2 &  7#c7
 9 cont9u+ ! receipt ( su* s]vices )\t  
int]ruption dur+ a p]man5t *ange (      
/ation = su* memb]s4  #bje4 ,coord9ation
 betwe5 ,dep>tm5t ( ,def5se & ,dep>tm5t 
( ,vet]ans ,affairs on furni%+ ( assi/$ 
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+  7a7 ,9 g5]al ,! 
,secret>y ( ,def5se & ! ,secret>y (     
,vet]ans ,affairs %all %>e be/ practices
 & facilitate ref]rals1 z !y consid]    
appropriate1 on ! furni%+ ( assi/$      

reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ to individuals   
eligible = ! receipt ( su* c\nsel+ &    
s]vices f ! ,secret>ies4  7b7 ,memor&um 
( und]/&+ ,! ,secret>y ( ,def5se & !    
,secret>y ( ,vet]ans ,affairs %all ent] 
into a memor&um ( und]/&+ provid+ t !   
,secret>y ( ,def5se w ensure access by !
 ,secret>y ( ,vet]ans ,affairs to       
reproductive g5etic mat]ial1 su* z      
oocytes1 sp]m1 f]tiliz$ eggs1 & embryos1
 ( vet]ans /or$ by ! ,dep>tm5t ( ,def5se
 = purposes ( furni%+ assi/$            
reproductive te*nology & intraut]9e     
insem9ation "u section #agbj,m ( title  
#ch1 ,unit$ ,/ates ,code1 z add$ by     
section #bab7;a74  #bjf4 ,regulations ,n
 lat] ?an two ye>s aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y (      
,def5se %all prescribe regulations to   
c>ry out ?is subtitle4  ,b ,reproductive
 assi/ance = vet]ans  #baa4 ,inclusion (
 assi/$ reproductive te*nology1         
intraut]9e insem9ation1 & c\nsel+ "u !  
def9ition ( m$ical s]vices 9 title #ch  

,section #agja7f7 ( title #ch1 ,unit$   
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+ new subp>agraph3  7,j7 ,assi/$ 
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ "u section       
#agbj,m ( ?is title4  4  #bab4 ,assi/$  
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ = c]ta9 vet]ans &
 sp\ses1 p>tn]s1 & ge/ational surrogates
 ( su* 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,m4 ,assi/$ 
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ = c]ta9 vet]ans &
 sp\ses1 p>tn]s1 & ge/ational surrogates
 ( su* vet]ans  7a7 ,requirem5t  7#a7 ,9
 g5]al ,not)/&+ any o!r provision ( law1
 includ+ ! surrogacy laws ( any ,/ate1 !
 ,secret>y %all furni% assi/$           
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ = ! b5efit ( a   
cov]$ vet]an to ! vet]an & ! sp\se1     
p>tn]1 gamete donor1 or ge/ational      
surrogate ( ! vet]an if ! vet]an1 & !   

sp\se1 p>tn]1 gamete donor1 or          
ge/ational surrogate ( ! vet]an1 z      
applicable1 ea* provide in=m$ cons5t =  
su* assi/$ reproductive te*nology1      
intraut]9e insem9ation1 & c\nsel+1      
includ+ = ea* cycle ( treatm5t au?oriz$ 
"u ?is section1 ?r\gh a process         
prescrib$ by ! ,secret>y4  7#b7         
,provision ( treatm5t & c\nsel+ ,assi/$ 
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ %all be furni%$  
"u p>agraph 7#a7 )\t reg>d to ! sex1    
sexual *>act]i/ics1 g5d] id5tity1 sexual
 ori5tation1 inf]tility diagnosis1 or   
m>ital /atus ( ! cov]$ vet]an or _!     
p>tn]4  7#c7 ,9 vitro f]tilization ,9 ! 
case ( 9 vitro f]tilization treatm5t    
furni%$ "u p>agraph 7#a71 ! ,secret>y   
%all furni% to an individual "u su*     
p>agraph-- 7,a7 n m ?an ?ree complet$   
oocyte retrievals2 &  7,b7 unlimit$     
embryo transf]s4  7#d7 ,copaym5t ,!     
,secret>y %all only furni% assi/$       
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ "u p>agraph 7#a7 

to a cov]$ vet]an :o is requir$ to pay  
to ! ,unit$ ,/ates a copaym5t am\nt z a 
condition = ! receipt ( hospital c>e1   
m$ical s]vices1 or m$ications "u ?is    
*apt] if ! cov]$ vet]an agrees to pay   
su* applicable copaym5t am\nt to !      
,unit$ ,/ates = su* assi/$ reproductive 
te*nology & c\nsel+4  7b7 ,procurem5t ( 
reproductive g5etic mat]ial  7#a7 ,9    
g5]al ,if a cov]$ vet]an is unable to   
provide _! reproductive g5etic mat]ial =
 purposes ( assi/$ reproductive         
te*nology or intraut]9e insem9ation "u  
subsection 7a71 ! ,secret>y %all1 at !  
election ( su* vet]an-- 7,a7 all[ su*   
vet]an to receive assi/$ reproductive   
te*nology or intraut]9e insem9ation )   
donat$ reproductive g5etic mat]ial1 if !
 donor provides in=m$ cons5t = use ( su*
 mat]ial2 &  7,b7 pay or reimburse !    
vet]an1 donor1 or a p>ty act+ on behalf 
( ! donor ! reasonable co/s ( procur+   
su* mat]ial f ! donor4  7#b7 ,o!r       
exp5ses ,! ,secret>y may pay or         
reimburse a cov]$ vet]an a reasonable   

am\nt = p]sonal travel & incid5tal      
exp5ses associat$ ) procur+ mat]ial f a 
donor "u p>agraph 7#a74  7c7 ,outrea* & 
tra9+ ,! ,secret>y %all c>ry out an     
outrea* & tra9+ program to ensure       
vet]ans & heal? c>e provid]s ( !        
,dep>tm5t are aw>e (-- 7#a7 !           
availability ( & eligibility requirem5ts
 = assi/$ reproductive te*nology1       
intraut]9e insem9ation1 & c\nsel+ "u ?is
 section2 &  7#b7 any *anges to assi/$  
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ cov]$ "u ?is     
section4  7d7 ,own]%ip1 use1 or         
disposition ( reproductive g5etic       
mat]ial  7#a7 ,9 g5]al ,issues or       
disputes reg>d+ use or disposition (    
reproductive g5etic mat]ial "u ?is      
section %all be ! sole responsibility ( 
! cov]$ vet]an1 ! sp\se or p>tn] ( !    
cov]$ vet]an1 z applicable1 & ! private 
facility /or+ su* mat]ial4  7#b7        
,agreem5t reg>d+ donat$ reproductive    
g5etic mat]ial ,z a condition ( ! use ( 
donat$ gametes or embryos "u ?is        

section1 ! ?ird-p>ty donor & a provid] (
 assi/$ reproductive te*nology or       
intraut]9e insem9ation t has ent]$ into 
a contract or agreem5t ) ! ,secret>y to 
provide assi/$ reproductive te*nology or
 intraut]9e insem9ation "u ?is section  
%all ent] into an arrangem5t or agreem5t
 gov]n+ ! t]ms ( ! donation1 includ+ h[ 
any rema9+ cryopres]v$ & /or$           
reproductive g5etic mat]ial w be h&l$   
once a cov]$ vet]an has exhau/$ ! assi/$
 reproductive te*nology or intraut]9e   
insem9ation s]vices available "u ?is    
section1 unless ! vet]an or ! sp\se or  
p>tn] ( ! vet]an has agre$ to assume    
liability = ! cont9u$ pres]vation ( any 
rema9+ gametes or embryos & ! ,dep>tm5t 
is n p>ty to ! arrangem5t or agreem5t = 
su* cont9u$ pres]vation4  7#c7 ,role (  
,dep>tm5t ,! role ( ! ,secret>y "u ?is  
section is limit$ to furni%+ assi/$     
reproductive te*nology1 intraut]9e      
insem9ation1 & c\nsel+ requir$ "u ?is   
section :5 reque/$ by a cov]$ vet]an &  
det]m9$ necess>y by ! ,secret>y4  7#d7  

,own]%ip & cu/ody ( reproductive g5etic 
mat]ial ,! ,secret>y w n h own]%ip or   
cu/ody ( any reproductive g5etic mat]ial
 obta9$ pursuant to treatm5t "u ?is     
section & w n be involv$ 9 disputes     
betwe5 or among any p>ties ) respect to 
su* mat]ial4  7e7 ,rule ( con/ruction   
,no?+ 9 ?is section %all be con/ru$ to  
require ! ,secret>y-- 7#a7 to f9d or    
c]tify a ge/ational surrogate = a cov]$ 
vet]an or to connect a ge/ational       
surrogate ) a cov]$ vet]an2 or  7#b7 to 
furni% mat]nity c>e to a cov]$ vet]an or
 sp\se1 p>tn]1 or ge/ational surrogate (
 a cov]$ vet]an beyond :at is o!rwise   
requir$ or au?oriz$ by law4  7f7        
,def9itions ,9 ?is section3 7#a7 ,! t]m 
assi/$ reproductive te*nology means any 
treatm5t or proc$ure t includes ! h&l+ (
 human eggs or embryos to help a*ieve a 
pregnancy1 includ+ 9 vitro f]tilization1
 egg or embryo cryopres]vation1 & egg or
 embryo donation4 ,su* t]m includes any 
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#b7 ,! t]m cov]$ vet]an     

means a vet]an :o is enroll$ 9 ! sy/em (
 annual pati5t enrollm5t e/abli%$ "u    
section #agje7;a7 ( ?is title4  7#c7 ,! 
t]m ge/ational surrogate means an       
individual :o agrees to attempt to      
become pregnant ?r\gh 9 vitro           
f]tilization "u a ge/ational surrogacy  
agreem5t us+ gametes t are n ! gametes (
 t individual4  7#d7 ,! t]m intraut]9e  
insem9ation means a proc$ure t places   
sp]m directly into an individual's ut]us
 at ! "t ( ! individual's ovulation to  
increase ! *ances ( f]tilization4 ,su*  
t]m includes any m$ication associat$ )  
su* a proc$ure4  7#e7 ,! t]m p>tn]1 )   
respect to a cov]$ vet]an1 means an     
individual select$ by ! vet]an :o agrees
 to be a p>5t1 ) ! vet]an1 ( a *ild born
 z a result ( ! use ( any assi/$        
reproductive te*nology or intraut]9e    
insem9ation "u ?is section4  4  7b7     
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #ag ( su* title is     
am5d$ by ins]t+ aft] ! item relat+ to   
section #agbj,l ! foll[+ new item3      

#agbj,m4 ,assi/$ reproductive te*nology1
 intraut]9e insem9ation1 & c\nsel+ =    
c]ta9 vet]ans & sp\ses1 p>tn]s1 &       
ge/ational surrogates ( su* vet]ans4  4 
7c7 ,sunset ( exi/+ au?ority ,! au?ority
 "u section #bcd7;a77#a7 ( ! ,milit>y   
,con/ruction1 ,vet]ans ,affairs1 &      
,relat$ ,ag5cies ,appropriations ,act1  
#bjbd 7division ,a ( ,public ,law       
#aah-db71 or any simil> au?ority        
subsequ5tly enact$ by law1 %all cease on
 ! effective date ( regulations         
prescrib$ to c>ry out section #agbj,m ( 
title #ch1 ,unit$ ,/ates ,code1 z add$  
by subsection 7a74  #bac4 ,assi/ance ) &
 cont9uity ( c>e reg>d+ reproductive &  
f]tility pres]vation s]vices ,!         
,secret>y ( ,vet]ans ,affairs %all      
ensure t employees ( ! ,dep>tm5t (      
,vet]ans ,affairs assi/ vet]ans-- 7#a7 9
 navigat+ ! s]vices provid$ "u ?is      
subtitle & ! am5dm5ts made by ?is       
subtitle2  7#b7 9 f9d+ a provid] t meets
 ! ne$s ( su* vet]ans ) respect to su*  
s]vices2 &  7#c7 9 cont9u+ ! receipt (  

su* s]vices )\t int]ruption if su*      
vet]ans move to a diff]5t geographic    
location4  #bad4 ,coord9ation (         
reproduction & f]tility rese>* = vet]ans
  7a7 ,9 g5]al ,sub*apt] ,,ii ( *apt]   
#gc ( title #ch1 ,unit$ ,/ates ,code1 is
 am5d$ by add+ at ! end ! foll[+ new    
section3  #gccj;,e4 ,coord9ation (      
reproduction & f]tility rese>* = vet]ans
  7a7 ,coord9ation ( rese>* requir$ ,!  
,secret>y %all coord9ate ) ! ,secret>y (
 ,def5se & ! ,secret>y ( ,heal? & ,human
 ,s]vices to conduct rese>* to improve !
 ability ( ! ,dep>tm5t ( ,vet]ans       
,affairs to meet ! long-t]m reproductive
 heal? c>e ne$s ( vet]ans :o h a        
condition t affects ! ability ( !       
individual to reproduce4  7b7           
,dissem9ation ( in=mation ,! ,secret>y  
%all ensure t in=mation produc$ by !    
rese>* "u ?is section t may be useful = 
o!r activities ( ! ,dep>tm5t is         
dissem9at$ ?r\gh\t ! ,dep>tm5t4  4  7b7 
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #gc ( su* title is     

am5d$ by ins]t+ aft] ! item relat+ to   
section #gccj;,d ! foll[+ new item3     
#gccj;,e4 ,coord9ation ( reproduction & 
f]tility rese>* = vet]ans4  4  ,,iii    
,access to assi/$ reproductive te*nology
 & intraut]9e insem9ation  #cja4 ,%ort  
title ,?is title may be cit$ z ! ,access
 to ,f]tility ,treatm5t & ,c>e ,act4    
#cjb4 ,/&>ds relat+ to b5efits = assi/$ 
reproductive te*nology & intraut]9e     
insem9ation  7a7 ,9 g5]al  7#a7 ,,phsa  
,"p ,d ( title ,,xxvii ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#aaa et seq47 is am5d$ by add+  
at ! end ! foll[+3  #bgii;,a-#ab4 ,/&>ds
 relat+ to b5efits = assi/$ reproductive
 te*nology & intraut]9e insem9ation  7a7
 ,9 g5]al ,a gr\p heal? plan or a heal? 
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all provide    
cov]age = assi/$ reproductive te*nology 
& intraut]9e insem9ation4  7b7          
,def9ition  7#a7 ,assi/$ reproductive   
te*nology2 ,,art ,! t]m assi/$          
reproductive te*nology or ,,art means   

any treatm5t or proc$ure t includes !   
h&l+ ( human eggs or embryos to help    
a*ieve a pregnancy1 includ+ 9 vitro     
f]tilization1 egg or embryo             
cryopres]vation1 & egg or embryo        
donation4 ,su* t]m includes any         
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#b7 ,intraut]9e insem9ation2
 ,,iui ,! t]m intraut]9e insem9ation or 
,,iui means a proc$ure t places sp]m    
directly into an individual's ut]us at !
 "t ( ! individual's ovulation to       
increase ! *ances ( f]tilization4 ,su*  
t]m includes any m$ication associat$ )  
su* a proc$ure4  7c7 ,requir$ cov]age ,a
 gr\p heal? plan & a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age %all provide cov]age =
 ,,art & ,,iui det]m9$ appropriate by ! 
heal? c>e provid]1 reg>dless ( :e!r !   
p>ticipant1 b5efici>y1 or enrollee      
receiv+ ,,art or ,,iui has be5 diagnos$ 
) inf]tility z def9$ by ! ,am]ican      
,society = ,reproductive ,m$ic9e1 if !  
,,art or ,,iui is p]=m$ at1 or prescrib$

 by1 a lic5s$ m$ical facility4  7d7     
,limitation ,co/-%>+1 includ+ d$uctibles
 & co9surance1 or o!r limitations =     
,,art or ,,iui may n be impos$ ) respect
 to ,,art or ,,iui requir$ to be cov]$  
"u subsection 7c7 to ! ext5t t su*      
co/-%>+ exce$s ! co/-%>+ appli$ to o!r  
m$ical s]vices "u ! gr\p heal? plan or  
heal? insurance cov]age or su* o!r      
limitations are diff]5t f limitations   
impos$ ) respect to su* m$ical s]vices1 
except :]e su* limitation is m favorable
 ) respect to ,,art or ,,iui4 ,!        
,secret>y %all promulgate int]im f9al   
regulations to c>ry out ?is subsection1 
not)/&+ ! notice & comm5t requirem5ts ( 
section #eec ( title #e1 ,unit$ ,/ates  
,code4  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>ticipant1 b5efici>y1 
or enrollee to enc\rage su* p>ticipant1 
b5efici>y1 or enrollee n to seek or     
obta9 ,,art or ,,iui to :i* su*         

p>ticipant1 b5efici>y1 or enrollee is   
entitl$ "u ?is section or to provid]s to
 induce su* provid]s n to provide       
m$ically appropriate ,,art or ,,iui to  
p>ticipants1 b5efici>ies1 or enrollees2 
7#b7 prohibit a provid] f discuss+ ) a  
p>ticipant1 b5efici>y1 or enrollee ,,art
 or ,,iui relat+ to ?is section2  7#c7  
p5alize or o!rwise r$uce or limit !     
reimbursem5t ( a provid] because su*    
provid] provid$ ,,art or ,,iui to a     
qualifi$ p>ticipant1 b5efici>y1 or      
enrollee 9 accordance ) ?is section2 or 
7#d7 on ! gr\nd prohibit$ "u title ,,vi 
( ! ,civil ,rights ,act ( #aifd1 title  
,,ix ( ! ,education ,am5dm5ts ( #aigb1 !
 ,age ,discrim9ation ,act ( #aige1      
section #ejd ( ! ,rehabilitation ,act ( 
#aigc1 or section #aeeg ( ! ,pati5t     
,protection & ,af=dable ,c>e ,act1      
exclude any individual f cov]age 9      
accordance ) ?is section1 or discrim9ate
 aga9/ any individual ) respect to su*  
cov]age4  7f7 ,rule ( con/ruction ,no?+ 
9 ?is section %all be con/ru$ to require

 a p>ticipant1 b5efici>y1 or enrollee to
 und]go ,,art or ,,iui4  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>ticipant1 b5efici>y1 & enrollee  
"u su* plan or cov]age 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$-- 7#a7 n lat] ?an ! e>li] (--
 7,a7 9 ! fir/ /&>d mail+ made by ! plan
 or issu] to ! p>ticipant1 b5efici>y1 or
 enrollee foll[+ ! effective date ( su* 
regulations2  7,b7 z "p ( any ye>ly     
in=mational packet s5t to ! p>ticipant1 
b5efici>y1 or enrollee2 or  7,c7 ,janu>y
 #a1 #bjbg2  7#b7 9 ! case ( a          
p>ticipant1 b5efici>y1 or enrollee n    
enroll$ 9 ! plan or cov]age on ! date ( 
transmission "u p>agraph 7#a71 ^u       
initial enrollm5t ( su* p>ticipant1     

b5efici>y1 or enrollee2 &  7#c7 on an   
annual basis aft] ! transmission "u     
p>agraph 7#a7 or 7#b74  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  7#b7     
,,erisa  7,a7 ,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 add+ at ! end !       
foll[+3  #gbg4 ,/&>ds relat+ to b5efits 
= assi/$ reproductive te*nology &       
intraut]9e insem9ation  7a7 ,9 g5]al ,a 
gr\p heal? plan or a heal? insurance    
issu] (f]+ gr\p heal? insurance cov]age 
%all provide cov]age = assi/$           
reproductive te*nology & intraut]9e     
insem9ation4  7b7 ,def9itions  7#a7     
,assi/$ reproductive te*nology or ,,art 
,! t]m assi/$ reproductive te*nology or 

,,art means any treatm5t or proc$ure t  
includes ! h&l+ ( human eggs or embryos 
to help a*ieve a pregnancy1 includ+ 9   
vitro f]tilization1 egg or embryo       
cryopres]vation1 & egg or embryo        
donation4 ,su* t]m includes any         
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#b7 ,intraut]9e insem9ation2
 ,,iui ,! t]m intraut]9e insem9ation or 
,,iui means a proc$ure t places sp]m    
directly into an individual's ut]us at !
 "t ( ! individual's ovulation to       
increase ! *ances ( f]tilization4 ,su*  
t]m includes any m$ication associat$ )  
su* a proc$ure4  7c7 ,requir$ cov]age ,a
 gr\p heal? plan & a heal? insurance    
issu] (f]+ gr\p heal? insurance cov]age 
%all provide cov]age = ,,art & ,,iui    
det]m9$ appropriate by ! heal? c>e      
provid]1 reg>dless ( :e!r ! p>ticipant  
or b5efici>y receiv+ ,,art or ,,iui has 
be5 diagnos$ ) inf]tility z def9$ by !  
,am]ican ,society = ,reproductive       
,m$ic9e1 if ! ,,art or ,,iui is p]=m$   
at1 or prescrib$ by1 a lic5s$ m$ical    

facility4  7d7 ,limitation ,co/-%>+1    
includ+ d$uctibles & co9surance1 or o!r 
limitations = ,,art or ,,iui may n be   
impos$ ) respect to ,,art or ,,iui      
requir$ to be cov]$ "u subsection 7c7 to
 ! ext5t t su* co/-%>+ exce$s ! co/-%>+ 
appli$ to o!r m$ical s]vices "u ! gr\p  
heal? plan or heal? insurance cov]age or
 su* o!r limitations are diff]5t f      
limitations impos$ ) respect to su*     
m$ical s]vices1 except :]e su*          
limitation is m favorable ) respect to  
,,art or ,,iui4 ,! ,secret>y %all       
promulgate int]im f9al regulations to   
c>ry out ?is subsection1 not)/&+ !      
notice & comm5t requirem5ts ( section   
#eec ( title #e1 ,unit$ ,/ates ,code4   
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 seek or    
obta9 ,,art or ,,iui 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 m$ically         
appropriate ,,art or ,,iui to           
p>ticipants or b5efici>ies2  7#b7       
prohibit a provid] f discuss+ ) a       
p>ticipant or b5efici>y ,,art or ,,iui  
relat+ to ?is section2  7#c7 p5alize or 
o!rwise r$uce or limit ! reimbursem5t ( 
a provid] because su* provid] provid$   
,,art or ,,iui to a qualifi$ p>ticipant 
or b5efici>y 9 accordance ) ?is section2
 or  7#d7 on ! gr\nd prohibit$ "u title 
,,vi ( ! ,civil ,rights ,act ( #aifd    
7#db ,u4,s4,c4 #bjjj;d et seq471 title  
,,ix ( ! ,education ,am5dm5ts ( #aigb   
7#bj ,u4,s4,c4 #afha et seq471 ! ,age   
,discrim9ation ,act ( #aige 7#db        
,u4,s4,c4 #faja et seq471 section #ejd (
 ! ,rehabilitation ,act ( #aigc 7#bi    
,u4,s4,c4 #gid71 or section #aeeg ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahaaf71 exclude any
 individual f cov]age 9 accordance ) ?is
 section1 or discrim9ate aga9/ any      
individual ) respect to su* cov]age4    

7f7 ,rule ( con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to require a    
p>ticipant or b5efici>y to und]go ,,art 
or ,,iui4  7g7 ,notice ,a gr\p heal?    
plan & a heal? insurance issu] (f]+ gr\p
 heal? insurance cov]age %all provide   
notice to ea* p>ticipant & b5efici>y "u 
su* plan or cov]age 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$-- 7#a7 n lat] ?an ! e>li] (--
 7,a7 9 ! fir/ /&>d mail+ made by ! plan
 or issu] to ! p>ticipant or b5efici>y  
foll[+ ! effective date ( su*           
regulations2  7,b7 z "p ( any ye>ly     
in=mational packet s5t to ! p>ticipant  
or b5efici>y2 or  7,c7 ,janu>y #a1      
#bjbg2  7#b7 9 ! case ( a p>ticipant or 
b5efici>y n enroll$ 9 ! plan or cov]age 
on ! date ( transmission "u p>agraph    
7#a71 ^u initial enrollm5t ( su*        

p>ticipant or b5efici>y2 &  7#c7 on an  
annual basis aft] ! transmission "u     
p>agraph 7#a7 or 7#b74  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 heal? insurance cov]age f negotiat+
 ! level & type ( reimbursem5t ) a      
provid] = c>e provid$ 9 accordance ) ?is
 section4  4  7,b7 ,cl]ical am5dm5t ,!  
table ( cont5ts 9 section #a ( !        
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #ajja et    
seq47 is am5d$ by ins]t+ aft] ! item    
relat+ to section #gbf ! foll[+ new     
item3  ,sec4 #gbg4 ,/&>ds relat+ to     
b5efits = assi/$ reproductive te*nology 
& intraut]9e insem9ation4  4  7#c7 ,,irc
  7,a7 ,9 g5]al ,sub*apt] ,b ( *apt]    
#ajj ( ! ,int]nal ,rev5ue ,code ( #aihf 
is am5d$ by add+ at ! end ! foll[+3     
#ihbg4 ,/&>ds relat+ to b5efits = assi/$
 reproductive te*nology & intraut]9e    
insem9ation  7a7 ,9 g5]al ,a gr\p heal? 
plan %all provide cov]age = assi/$      

reproductive te*nology & intraut]9e     
insem9ation4  7b7 ,def9ition  7#a7      
,assi/$ reproductive te*nology2 ,,art ,!
 t]m assi/$ reproductive te*nology or   
,,art means any treatm5t or proc$ure t  
includes ! h&l+ ( human eggs or embryos 
to help a*ieve a pregnancy1 includ+ 9   
vitro f]tilization1 egg or embryo       
cryopres]vation1 & egg or embryo        
donation4 ,su* t]m includes any         
m$ication relat$ to su* a treatm5t or   
proc$ure4  7#b7 ,intraut]9e insem9ation2
 ,,iui ,! t]m intraut]9e insem9ation or 
,,iui means a proc$ure t places sp]m    
directly into an individual's ut]us at !
 "t ( ! individual's ovulation to       
increase ! *ances ( f]tilization4 ,su*  
t]m includes any m$ication associat$ )  
su* a proc$ure4  7c7 ,requir$ cov]age ,a
 gr\p heal? plan %all provide cov]age = 
,,art & ,,iui det]m9$ appropriate by !  
heal? c>e provid]1 reg>dless ( :e!r !   
p>ticipant or b5efici>y receiv+ ,,art or
 ,,iui has be5 diagnos$ ) inf]tility z  
def9$ by ! ,am]ican ,society =          

,reproductive ,m$ic9e1 if ! ,,art or    
,,iui is p]=m$ at1 or prescrib$ by1 a   
lic5s$ m$ical facility4  7d7 ,limitation
 ,co/-%>+1 includ+ d$uctibles &         
co9surance1 or o!r limitations = ,,art  
or ,,iui may n be impos$ ) respect to   
,,art or ,,iui requir$ to be cov]$ "u   
subsection 7c7 to ! ext5t t su* co/-%>+ 
exce$s ! co/-%>+ appli$ to o!r m$ical   
s]vices "u ! gr\p heal? plan or heal?   
insurance cov]age or su* o!r limitations
 are diff]5t f limitations impos$ )     
respect to su* m$ical s]vices1 except   
:]e su* limitation is m favorable )     
respect to ,,art or ,,iui4 ,! ,secret>y 
%all promulgate int]im f9al regulations 
to c>ry out ?is subsection1 not)/&+ !   
notice & comm5t requirem5ts ( section   
#eec ( title #e1 ,unit$ ,/ates ,code4   
7e7 ,prohibitions ,a gr\p heal? plan 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 seek or obta9 ,,art or ,,iui 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 m$ically      
appropriate ,,art or ,,iui to           
p>ticipants or b5efici>ies2  7#b7       
prohibit a provid] f discuss+ ) a       
p>ticipant or b5efici>y ,,art or ,,iui  
relat+ to ?is section2  7#c7 p5alize or 
o!rwise r$uce or limit ! reimbursem5t ( 
a provid] because su* provid] provid$   
,,art or ,,iui to a qualifi$ p>ticipant 
or b5efici>y 9 accordance ) ?is section2
 or  7#d7 on ! gr\nd prohibit$ "u title 
,,vi ( ! ,civil ,rights ,act ( #aifd    
7#db ,u4,s4,c4 #bjjj;d et seq471 title  
,,ix ( ! ,education ,am5dm5ts ( #aigb   
7#bj ,u4,s4,c4 #afha et seq471 ! ,age   
,discrim9ation ,act ( #aige 7#db        
,u4,s4,c4 #faja et seq471 section #ejd (
 ! ,rehabilitation ,act ( #aigc 7#bi    
,u4,s4,c4 #gid71 or section #aeeg ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahaaf71 exclude any
 individual f cov]age 9 accordance ) ?is
 section1 or discrim9ate aga9/ any      
individual ) respect to su* cov]age4    

7f7 ,rule ( con/ruction ,no?+ 9 ?is     
section %all be con/ru$ to require a    
p>ticipant or b5efici>y to und]go ,,art 
or ,,iui4  7g7 ,notice ,a gr\p heal?    
plan %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 & %all 
be transmitt$-- 7#a7 n lat] ?an ! e>li] 
(-- 7,a7 9 ! fir/ /&>d mail+ made by !  
plan to ! p>ticipant or b5efici>y foll[+
 ! effective date ( su* regulations2    
7,b7 z "p ( any ye>ly in=mational packet
 s5t to ! p>ticipant or b5efici>y2 or   
7,c7 ,janu>y #a1 #bjbg2  7#b7 9 ! case (
 a p>ticipant or b5efici>y n enroll$ 9 !
 plan on ! date ( transmission "u       
p>agraph 7#a71 ^u initial enrollm5t (   
su* p>ticipant or b5efici>y2 &  7#c7 on 
an annual basis aft] ! transmission "u  
p>agraph 7#a7 or 7#b74  7h7 ,level &    

type ( reimbursem5ts ,no?+ 9 ?is section
 %all be con/ru$ to prev5t a gr\p heal? 
plan f negotiat+ ! level & type (       
reimbursem5t ) a provid] = c>e provid$ 9
 accordance ) ?is section4  4  7,b7     
,cl]ical am5dm5t ,! table ( sections =  
sub*apt] ,b ( *apt] #ajj ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+ new item3  ,sec4      
#ihbg4 ,/&>ds relat+ to b5efits = assi/$
 reproductive te*nology & intraut]9e    
insem9ation4  4  7b7 ,con=m+ am5dm5ts   
7#a7 ,,phsa ,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 & #bgii;,a-#ab4  7#b7 ,,erisa     
,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 & #gbg4  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 "o or m        
collective b>ga9+ agreem5ts betwe5      
employee repres5tatives & "o 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 ,act72 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  #cjc4      
,requirem5t = ,/ate ,m$icaid plans to   
provide m$ical assi/ance = assi/$       

reproductive te*nology & intraut]9e     
insem9ation  7a7 ,9 g5]al ,section #aije
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9    
subsection 7a77#d77;,c71 by ins]t+ 7:i* 
%all include assi/$ reproductive        
te*nology 7,,art7 & intraut]9e          
insem9ation 7,,iui7 provid$ 9 accordance
 ) subsection 7ll77 aft] family plann+  
s]vices & supplies2 &  7#b7 by add+ at !
 end ! foll[+ new subsection3  7ll7     
,requirem5ts = cov]age ( assi/$         
reproductive te*nology & intraut]9e     
insem9ation ,= purposes ( subsection    
7a77#d77;,c71 a ,/ate %all ensure t !   
m$ical assi/ance provid$ "u ! ,/ate plan
 7or waiv] ( su* plan7 = assi/$         
reproductive te*nology 7,,art7 &        
intraut]9e insem9ation 7,,iui7 complies 
) ! requirem5ts ( section               
#bgii;,a-#ab7;b7 ( ! ,public ,heal?     
,s]vice ,act 9 ! same mann] z su*       
requirem5ts & limitations apply to heal?
 insurance cov]age (f]$ by a gr\p heal? 
plan or heal? insurance issu]4  4  7b7  

,te*nical am5dm5t ,section #aijc7;a77#e7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;b7a77#e77 is am5d$ by   
ins]t+ describ$ 9 section               
#aije7;a77#d77;,c7 aft] family plann+   
s]vices & supplies4  7c7 ,effective date
  7#a7 ,9 g5]al ,except z provid$ 9     
p>agraph 7#b71 ! am5dm5ts made by ?is   
section %all take effect on ,octob] #a1 
#bjbg4  7#b7 ,delay p]mitt$ if ,/ate    
legislation requir$ ,9 ! case ( a ,/ate 
plan approv$ "u title ,,xix ( ! ,social 
,security ,act :i* ! ,secret>y ( ,heal? 
& ,human ,s]vices det]m9es requires     
,/ate legislation 7o!r ?an legislation  
appropriat+ funds7 9 ord] = ! plan to   
meet ! additional requirem5t impos$ by  
?is section1 ! ,/ate plan %all n be     
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( !      
failure ( ! plan to meet su* additional 
requirem5t be=e ! fir/ day ( ! fir/     
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t ends aft] ! #a-ye> p]iod  

beg9n+ ) ! date ( ! enactm5t ( ?is      
section4 ,= purposes ( ! prec$+ s5t5ce1 
9 ! case ( a ,/ate t has a #b-ye>       
legislative session1 ea* ye> ( ! session
 is deem$ to be a sep>ate regul> session
 ( ! ,/ate legislature4  #cjd4 ,m$ic>e  
cov]age ( assi/$ reproductive te*nology 
& intraut]9e insem9ation  7a7 ,cov]age  
,section #ahfa7s77#b7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciex7s77#b77 is am5d$-- 7#a7 9        
subp>agraph 7,,jj71 by /rik+ & at ! end2
  7#b7 9 subp>agraph 7,,kk71 by ins]t+ &
 at ! end2 &  7#c7 by add+ at ! end !   
foll[+ new subp>agraph3  7,,ll7 assi/$  
reproductive te*nology & intraut]9e     
insem9ation 7z def9$ 9 section          
#bgii;,a-#ab7;b7 ( ! ,public ,heal?     
,s]vice ,act72  4  7b7 ,paym5t & waiv] (
 co9surance ,section #ahcc7;a77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7a77#a77 is am5d$-- 7#a7 by /rik+ 
& be=e 7,,hh72 &  7#b7 by ins]t+ be=e ! 
semicolon at ! end ! foll[+3 1 & 7,,ii7 
) respect to assi/$ reproductive        

te*nology & intraut]9e insem9ation 7z   
describ$ 9 section #ahfa7s77#b77,,ll771 
! am\nt paid %all be equal to #ajj p]c5t
 ( ! less] ( ! actual *>ge = ! treatm5t 
or ! am\nt det]m9$ "u ! paym5t basis    
det]m9$ "u section #ahdh4  7c7 ,waiv] ( 
application ( d$uctible ,! fir/ s5t5ce (
 section #ahcc7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciel7b77 is      
am5d$-- 7#a7 by /rik+ 1 & 7#ac7 & ins]t+
 7#ac72 &  7#b7 by /rik+ #ahfa7n744 &   
ins]t+ #ahfa7n71 & 7#ad7 su* d$uctible  
%all n apply ) respect to assi/$        
reproductive te*nology 7z describ$ 9    
section #ahfa7s77#b77,,ll7744  7d7      
,paym5t "u physician fee s*$ule ,section
 #ahdh7;j77#c7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77  
is am5d$ by ins]t+ 7#b77,,ll7 aft] risk 
assessm5t714  7e7 ,con=m+ am5dm5t reg>d+
 cov]age ,section #ahfb7;a77#a77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciey7a77#a77;,a77 is am5d$ by ins]t+ 1
 or assi/$ reproductive te*nology 7z    
describ$ 9 section #ahfa7s77#b77,,ll77 &

 intraut]9e insem9ation aft]            
#ahfa7;ddd77#a774  7f7 ,effective date  
,! am5dm5ts made by ?is section %all    
apply to s]vices furni%$ on or aft]     
,janu>y #a1 #bjbg4  ,,iv ,family build+ 
,,fehb fairness  #dja4 ,%ort title ,?is 
title may be cit$ z ! ,family ,build+   
,,fehb ,fairness ,act4  #djb4 ,assi/$   
reproductive te*nology & intraut]9e     
insem9ation b5efits  7a7 ,9 g5]al       
,section #hijd ( title #e1 ,unit$ ,/ates
 ,code1 is am5d$-- 7#a7 9 subsection    
7a7-- 7,a7 9 p>agraph 7#a71 by add+ at !
 end ! foll[+3  7,g7 ,assi/$            
reproductive te*nology & intraut]9e     
insem9ation b5efits4  2 &  7,b7 9       
p>agraph 7#b7-- 7i7 by r$esignat+       
subp>agraph 7,f7 z subp>agraph 7,g72 &  
7ii7 by ins]t+ aft] subp>agraph 7,e7 !  
foll[+3  7,f7 ,assi/$ reproductive      
te*nology & intraut]9e insem9ation      
b5efits4  2 &  7#b7 by add+ at ! end !  
foll[+3  7c7 ,def9itions ,9 ?is section1
 ! t]ms assi/$ reproductive te*nology & 
intraut]9e insem9ation h ! mean+s giv5  

su* t]ms 9 section #ajc ( ! ,"r to ,,ivf
 ,act ( #bjbf4  4  7b7 ,effective date  
,! am5dm5ts made by ?is section %all    
take effect on ! date t is #a ye> aft] !
 date ( enactm5t ( ?is ,act4