PRINTER'S NO. 2182
No. 352 Session of 2005
INTRODUCED BY BUNT, JUNE 14, 2005
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
JUNE 14, 2005
A RESOLUTION
1 Directing the Pennsylvania Health Care Cost Containment Council
2 to conduct a study concerning the requirement of
3 comprehensive insurance coverage for the diagnosis and
4 treatment of infertility.
5 WHEREAS, The commonly accepted definition of infertility is
6 12 months or more of unprotected intercourse without pregnancy
7 for a woman under 35 years of age or six months for a woman 35
8 years of age or older; and
9 WHEREAS, There is an effective and established continuum of
10 care for treating infertility through assisted reproductive
11 technology; and
12 WHEREAS, Most insurance plans already provide some
13 infertility coverage through major medical benefits and
14 pregnancy or maternity benefits; and
15 WHEREAS, Many couples facing infertility today are compelled
16 to choose treatment within the parameters of their insurance
17 coverage rather than what is medically less invasive, less
18 costly, less risky, more effective and therefore more
1 appropriate; and
2 WHEREAS, Employers would rather spend their insurance
3 premiums on equally or less costly, more effective fertility
4 care occurring over a shorter period of time than now required;
5 and
6 WHEREAS, It is well documented that states requiring health
7 insurance for assisted reproductive technologies have a far
8 lower incidence of multiple births (twins, triplets or higher)
9 than other states; and
10 WHEREAS, Reducing the incidence of multiple births from
11 better use of and improved access to the full continuum of
12 assisted reproductive technologies will reduce current insurance
13 expenditures; and
14 WHEREAS, A reduction in the number of multiple births
15 constitutes a significant improvement in infertility treatment
16 overall, resulting in less risk to mother and child, less costly
17 prenatal and delivery care and reduced time in and expenditures
18 borne by insurers for neonatal intensive care; and
19 WHEREAS, Pennsylvania needs to improve access to
20 comprehensive infertility treatment that is already available to
21 State employees and to some municipal employees and to residents
22 in Maryland, Massachusetts, New Jersey, New York, Ohio and West
23 Virginia; and
24 WHEREAS, Lack of comprehensive infertility coverage places
25 Pennsylvania industry in a less competitive position with
26 respect to access among similar industries in surrounding
27 states; and
28 WHEREAS, To deny potentially successful treatment of the
29 disease of infertility is wrong, especially since it has been
30 demonstrated that the cost of requiring comprehensive
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1 infertility coverage is minimal, cost-neutral or possibly a
2 savings over treatments now commonly covered; and
3 WHEREAS, Infertility impacts a couple's general health, their
4 marriage, job performance and social interactions; and
5 WHEREAS, There is compelling actuarial data revealing that
6 the cost of infertility treatment adds little, if anything, to
7 the cost of insurance premiums and indeed might reduce costs by
8 limiting performance of less-effective treatments commonly
9 covered by insurance today; and
10 WHEREAS, Bargaining power on the part of the insurer will
11 further help drive down procedure and material costs for
12 treatment; therefore be it
13 RESOLVED, That the House of Representatives direct the
14 Pennsylvania Health Care Cost Containment Council to conduct a
15 study concerning the requirement of comprehensive insurance
16 coverage for the diagnosis and treatment of infertility
17 consistent with the following restrictions:
18 (1) Exclusion of elective sterilization reversal or use
19 of assisted reproductive technology when infertility is the
20 result of elective sterilization.
21 (2) Exclusion of services provided in connection with
22 the use of a surrogate gestational mother.
23 (3) Requiring waiting periods before assisted
24 reproductive technology may be employed, consistent with
25 recommended treatment guidelines issued by the American
26 Society for Reproductive Medicine (ASRM), the Society for
27 Reproductive Endocrinologists and Infertility (SREI) or the
28 American College of Obstetricians and Gynecologists (ACOG).
29 (4) Requiring the use of assisted reproductive
30 technology procedures to follow the recommended treatment
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1 guidelines issued by the ASRM, SREI or ACOG.
2 (5) Exclusion of coverage for women under 21 years of
3 age or over 45 years of age.
4 (6) Limiting coverage for assisted reproductive
5 technology to the policyholder and spouse or both.
6 (7) Requiring that in vitro fertilization (IVF), gamete
7 intrafallopian transfer (GIFT) or zygote intrafallopian
8 transfer (ZIFT) be performed at a reproductive health clinic
9 reporting annually to the Centers for Disease Control and
10 Prevention.
11 (8) Limiting coverage to four IVF, GIFT or ZIFT
12 procedures per live birth, with a maximum of eight cycles per
13 subscriber per lifetime.
14 (9) Excluding coverage for techniques or procedures
15 deemed experimental and/or investigational by the ASRM, SREI
16 or the ACOG.
17 (10) Requiring copayment or deductibles for assisted
18 reproductive technology procedures, which shall not exceed
19 those for all other pregnancy-related benefits, up to a
20 maximum of 20% of the cost of the procedure;
21 and be it further
22 RESOLVED, That the Pennsylvania Health Care Cost Containment
23 Council report its findings to the General Assembly by December
24 31, 2005.
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