PRINTER'S NO. 1699
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1493
Session of
2023
INTRODUCED BY MAYES, MADDEN, SANCHEZ, HILL-EVANS, FRANKEL,
INNAMORATO, SALISBURY, BOROWSKI, DELLOSO, O'MARA, KINSEY,
STEELE, CERRATO, PISCIOTTANO, KHAN, CEPEDA-FREYTIZ, WAXMAN,
SCOTT, DONAHUE, GUENST, ABNEY, A. BROWN, KAZEEM, KRAJEWSKI,
OTTEN, BURGOS, HANBIDGE, HOHENSTEIN, ROZZI AND GREEN,
JUNE 22, 2023
REFERRED TO COMMITTEE ON INSURANCE, JUNE 22, 2023
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 fertility preservation 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 635.9. Fertility Preservation Coverage.--(a) An
individual or group health insurance policy offered, issued or
renewed in this Commonwealth or a government program shall
include coverage for fertility preservation services as
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specified in subsection (b) and shall waive cost-sharing
requirements related to fertility preservation care.
(b) Fertility preservation specified under subsection (c)
shall apply to covered individuals not older than forty-five
(45) years of age who are at risk of iatrogenic infertility.
(c) Fertility preservation care services under this section
shall include services related to fertility preservation as a
result of iatrogenic infertility, including for the
consultation, diagnosis and treatment of iatrogenic infertility,
as well as the following:
(1) Cryopreservation and thawing of eggs, sperm and embryos.
(2) Cryopreservation of ovarian tissue.
(3) Cryopreservation of testicular tissue.
(4) Intrauterine insemination.
(5) Embryo biopsy.
(6) Diagnostic testing.
(7) Fresh and frozen embryo transfers.
(8) Egg retrievals with unlimited embryo transfers in
accordance with the guidelines determined by the Department of
Health. The guidelines should be informed by standards of
practice as developed by the American Society for Reproductive
Medicine, including the use of single embryo transfers when
recommended and medically appropriate.
(9) Assisted hatching.
(10) Intracytoplasmic sperm injection.
(11) Ovulation induction.
(12) Storage of oocytes, sperm, embryos and tissue.
(13) Medical and laboratory services that reduce excess
embryo creation through egg cryopreservation and thawing.
(14) Therapeutic devices.
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(15) 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.
(16) Any nonexperimental procedure for infertility
determined by the Department of Health.
(17) Any other services, procedures, medications or devices
related to the consultation, diagnosis and treatment for
fertility preservation.
(18) 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.
(d) A health insurance policy or government program covered
under this section may not:
(1) contain preexisting condition exclusions or preexisting
waiting periods to access fertility preservation care coverage
required under this section;
(2) contain limitations on coverage for fertility
preservation benefits based solely on arbitrary factors,
including the number of fertility preservation attempts or cost
of fertility preservation care.
(e) Storage requirements under subsection (c)(12) shall be
covered by a health insurance policy or a government program for
five consecutive years unless:
(1) If the covered individual receiving service coverage
under subsection (b) is not yet eighteen (18) years of age, in
addition to requirements under this subsection, a health
insurance policy or government program shall also cover storage
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requirements as necessary until the covered individual attains
eighteen (18) years of age.
(2) If a covered individual receiving services under
subsection (c)(12) under one health insurance policy or
government program changes coverage to another health insurance
policy or government program during the five-consecutive-year
window under this subsection, the subsequent health insurance
policy or government program shall continue to provide coverage
of services required under subsection (c)(12) for the remaining
storage time under this subsection.
(f) Nothing in this section shall be construed to interfere
with the clinical judgment of a physician.
(g) 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" means 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 or government program policy premium.
"Covered individual" means an individual covered under a
health insurance policy or government program, including covered
spouses and covered nonspouse dependents which is provided
without discrimination on the basis of ancestry, color,
disability, domestic partner status, gender, gender expression,
gender identity, genetic information, marital status, national
origin, race, religion, sex or sexual orientation.
"Fertility preservation" means health care services used in
saving or protecting embryos, eggs, ovarian tissue, sperm or
testicular tissue for future reproduction.
"Government program" means a program of government sponsored
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or subsidized health care coverage, including:
(1) The children's health insurance program under Article
XXIII-A.
(2) Subdivision (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21), known as the "Human Services Code."
"Health insurance policy" means as follows:
(1) The term includes an individual or group health
insurance policy, subscriber contract, certificate or plan that
provides medical or health care coverage on an expense-incurred
service or prepaid basis and that is offered by or is governed
under any of the following:
(i) This act, including section 630.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
(iii) 40 Pa.C.S. Chs. 61 (relating to hospital plan
corporations) and 63 (relating to professional health services
plan corporations).
(2) The term does not include any of the following plans:
(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 supplement (CHAMPUS).
(vii) Fixed indemnity.
(viii) Dental only.
(ix) Vision only.
(x) Workers' compensation.
(xi) An automobile medical payment under 75 Pa.C.S.
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(relating to vehicles).
"Iatrogenic infertility" means infertility arising from
medical treatments that directly or indirectly cause
infertility.
"Infertility" means a disease historically defined by the
failure to achieve a successful pregnancy after six to twelve
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" means an individual licensed as a medical doctor
by the State Board of Medicine to practice in this Commonwealth.
Section 2. The following shall apply:
(1) For health insurance policies for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this act shall apply to any
policy for which a form or rate is first filed on or after
the effective date of this section.
(2) For health insurance policies for which rates or
forms are required to be filed with the Federal Government or
the Insurance Department, this act shall apply to any policy
issued or renewed on or after 180 days after the effective
date of this section.
Section 3. This act shall take effect in 60 days.
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