PRINTER'S NO. 2489
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2142
Session of
2021
INTRODUCED BY MALAGARI, INNAMORATO, O'MARA, SANCHEZ, DELLOSO,
KINSEY, D. MILLER, T. DAVIS, MULLINS, SCHLOSSBERG, FREEMAN,
WEBSTER, HOWARD, N. NELSON, OTTEN, ROZZI, GUENST, LEE,
CEPHAS, SHUSTERMAN, DALEY, KRUEGER, McNEILL, FIEDLER, CIRESI
AND SIMS, DECEMBER 8, 2021
REFERRED TO COMMITTEE ON INSURANCE, DECEMBER 8, 2021
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for infertility care coverage.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.8. Infertility Care Coverage.--(a) A health
insurance policy covered under this section shall include
coverage for infertility care and shall waive cost-sharing
requirements related to infertility care.
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(b) Infertility care coverage under this section shall be
provided to covered individuals, including covered spouses and
covered nonspouse dependents. Infertility care coverage under
this section shall be provided without discrimination on the
basis of age, ancestry, color, disability, domestic partner
status, gender, gender expression, gender identity, genetic
information, marital status, national origin, race, religion,
sex or sexual orientation. Nothing in this subsection shall be
construed to interfere with the clinical judgment of a
physician.
(c) Infertility care coverage under this section shall be
for the consultation, diagnosis and treatment of infertility,
including the following:
(1) Intrauterine insemination.
(2) Cryopreservation and thawing of eggs, sperm and embryos.
(3) Cryopreservation of ovarian tissue.
(4) Cryopreservation of testicular tissue.
(5) Embryo biopsy.
(6) Diagnostic testing.
(7) Fresh and frozen embryo transfers.
(8) Egg retrievals with unlimited embryo transfers in
accordance with the guidelines of the American Society for
Reproductive Medicine, including the use of single embryo
transfers when recommended and medically appropriate.
(9) In vitro fertilization, including in vitro fertilization
through the use of donor eggs, sperm or embryos and in vitro
fertilization that involves the transfer of embryos to a
gestational carrier or surrogate.
(10) Assisted hatching.
(11) Intracytoplasmic sperm injection.
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(12) Infertility medications.
(13) Ovulation induction.
(14) Storage of oocytes, sperm, embryos and tissue.
(15) Surgery to address disorders of the female reproductive
tract that impair fertility and to address disorders of sperm
production or anatomic disorders of the male reproductive tract
that impair fertility.
(16) Medical and laboratory services that reduce excess
embryo creation through egg cryopreservation and thawing.
(17) Surrogacy, including the costs associated with the
preparation for reception or introduction of embryos, oocytes or
donor sperm into a surrogate or gestational carrier.
(18) Gamete intrafallopian transfers.
(19) Therapeutic devices.
(20) Standard fertility preservation services for an
individual who has a medical condition and is expected to
undergo medication therapy, surgery, radiation, chemotherapy or
other medical treatment that is recognized by a medical
professional to cause a risk of impairment to fertility.
(21) Any nonexperimental procedure for infertility
recognized by the American Society for Reproductive Medicine,
the American College of Obstetricians and Gynecologists or the
Society for Assisted Reproductive Technology or by an
infertility expert identified by the Department of Health.
(22) Any other services, procedures, medications or devices
related to the consultation, diagnosis and treatment of
infertility.
(d) A health insurance policy covered under this section may
not:
(1) contain preexisting condition exclusions, preexisting
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condition waiting periods to access the infertility care
coverage required under this section;
(2) use the prior diagnosis of infertility or prior
treatment for infertility as a basis for excluding, limiting or
otherwise restricting the availability of infertility care
coverage required under this section; or
(3) contain limitations on coverage for infertility benefits
based solely on arbitrary factors, including the number of
infertility care attempts or cost of infertility care.
(e) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Cost-sharing." The share of costs covered by the patient,
including a deductible, coinsurance, copayment or similar
charge. The term does not include the payment of a health
insurance policy premium.
"Health insurance policy." Any individual or group health
insurance policy, subscriber contract, certificate or plan that
provides medical or health care coverage by a health care
facility or licensed health care provider on an expense-incurred
service or prepaid basis and that is offered by or is governed
under any of the following:
(1) This act, including section 630.
(2) The children's health insurance program under Article
XXIII-A.
(3) Subdivision (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Human Services Code."
(4) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(5) 40 Pa.C.S. Chs. 61 (relating to hospital plan
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corporations) and 63 (relating to professional health services
plan corporations).
(6) The term does not include any of the following:
(i) Accident only.
(ii) Credit only.
(iii) Long-term care or disability income.
(iv) Specified disease.
(v) Medicare supplement.
(vi) Tricare, including the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) supplement.
(vii) Fixed indemnity.
(viii) Dental only.
(ix) Vision only.
(x) Workers' compensation.
(xi) An automobile medical payment under 75 Pa.C.S.
(relating to vehicles).
"Infertility." A disease historically defined by the failure
to achieve a successful pregnancy after six (6) to twelve (12)
months or more of regular, unprotected sexual intercourse or due
to an individual's status and capacity to reproduce as an
individual or with a partner.
"Physician." An individual licensed as a medical doctor by
the State Board of Medicine to practice in this Commonwealth.
Section 2. This act shall take effect in 60 days.
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