PRINTER'S NO. 365
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
381
Session of
2019
INTRODUCED BY BOSCOLA, COSTA, FONTANA, BREWSTER AND HAYWOOD,
MARCH 4, 2019
REFERRED TO BANKING AND INSURANCE, MARCH 4, 2019
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 coverage for infertility treatment.
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 633.1. Coverage for Infertility Treatment.--(a)
Every health insurance policy that provides pregnancy-related
benefits and is delivered, issued, executed or renewed in this
Commonwealth on or after the effective date of this section
shall provide coverage for the expenses of diagnosis and
treatment of infertility, including, but not limited to:
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(1) In vitro fertilization.
(2) Embryo transfer.
(3) Artificial insemination.
(4) Gamete intrafallopian tube transfer.
(5) Zygote intrafallopian tube transfer.
(6) Low tubal ovum transfer.
(b) The coverage required under subsection (a) may impose
the following restrictions:
(1) Exclude reversal of elective sterilization or use of
assisted reproductive techniques when infertility is the result
of elective sterilization.
(2) Restrictions or waiting periods before assisted
reproductive techniques may be employed. The restrictions or
waiting periods imposed must be within the recommended treatment
guidelines issued by the American Society for Reproductive
Medicine or the American College of Obstetricians and
Gynecologists.
(3) Exclude coverage for women beyond childbearing years.
(4) Restrict coverage for assisted reproductive techniques
to the policyholder and dependent spouse. All treatments to
remedy conditions that could impair fertility must be covered
for policyholder and all dependents, including minor children.
(5) Require that in vitro fertilization, gamete
intrafallopian tube transfer or zygote intrafallopian tube
transfer be performed at medical facilities that conform to the
American College of Obstetricians and Gynecologists guidelines
for in vitro fertilization clinics or to the American Society
for Reproductive Medicine minimal standards for programs of in
vitro fertilization.
(6) Impose a limitation of three assisted reproductive
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technology procedures that a covered individual may attempt.
(7) Require copayment or deductibles for assisted
reproductive technology treatments. Any copayment or deduction
may not exceed those applied to pregnancy-related benefits under
the same policy, contract or plan.
(c) The procedures required to be covered under this section
may be contained in any policy or plan issued to a religious
institution or organization or to any entity sponsored by a
religious institution or organization that finds the procedure
required to be covered under this section to violate its
religious and moral teachings and beliefs.
(d) As used in this section:
"H ealth insurance policy " means an individual or group health
insurance policy, contract or plan that provides medical or
health care coverage by any 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.
(2) Subdivision (f) of Article IV of the act of June 13,
1967 (P.L.31, No.21) , known as the "Human Services Code."
(3) The act of December 29, 1972 (P.L.1701, No.364) , known
as the "Health Maintenance Organization Act."
(4) The act of May 18, 1976 (P.L.123, No.54) , known as the
"Individual Accident and Sickness Insurance Minimum Standards
Act."
(5) A nonprofit corporation subject to 40 Pa.C.S. Ch. 61
(relating to hospital plan corporations) or 63 (relating to
professional health services plan corporations).
The term does not include accident only, fixed indemnity,
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limited benefit, credit, dental, vision, specified disease,
Medicare supplement, Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement, long-term care or
disability income, workers' compensation or automobile medical
payment insurance.
"Infertility " means the inability to conceive after one year
of unprotected sexual intercourse or the inability to sustain a
successful pregnancy.
Section 2. This act shall take effect in 60 days.
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