Summary
Makes sure that group health insurance plans that cover childbirth services also pay for treatments for people who have trouble getting pregnant.
What problem does this solve?
Many people need medical help to have a baby, but their health insurance doesn't pay for it, especially if other medical treatments cause infertility. This bill requires group health plans that cover childbirth to also cover treatments for infertility, including preserving fertility before a medical procedure.
Who does this affect?
- Individuals and couples with infertility
- Patients undergoing medical treatments that risk fertility
- Employers offering group health insurance
What does this bill do?
Reference
Text:
Section:
Sec. 714A(a)(1)
Header:
Standards relating to benefits for treatment of infertility
Mandates infertility coverage
Requires group health plans that cover childbirth services to also cover treatments for infertility.
Reference
Text:
Section:
Sec. 714A(a)(2)
Header:
Standards relating to benefits for treatment of infertility
Covers fertility preservation
Requires coverage for services like egg or sperm freezing when a necessary medical treatment, such as chemotherapy, is expected to cause infertility.
Ensures fair cost-sharing
Prohibits insurance plans from making patients pay more for infertility treatments than they do for most other medical and surgical services.
Bans negative incentives
Forbids health plans from offering money to patients or doctors to discourage them from using or providing covered infertility treatments.
Establishes penalties for non-compliance
Allows the government to fine an insurance company up to $100 per day for each person who is wrongly denied coverage for infertility treatments.
Requires reporting and oversight
Makes insurance companies report to the government for five years on how they manage infertility benefits to ensure they are following the rules.
Defines infertility
Provides clear medical definitions for what qualifies as infertility, including conditions caused by other medical treatments.
What is the real world impact?
•
Expands access to family-building options
Makes it easier and more affordable for people to start or grow their families by requiring insurance to cover expensive fertility treatments. This helps people who cannot get pregnant naturally.
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Protects fertility for patients with serious illnesses
Ensures that patients undergoing treatments like chemotherapy can freeze their eggs or sperm beforehand. This gives them a chance to have children later, which their medical treatment might otherwise prevent.
•
Could increase health insurance costs
Requires coverage for costly procedures, which could cause insurance companies to raise monthly payments for everyone in a group health plan. This might increase costs for employers and employees, even those who do not need these services.
When does this start?
The main requirements for insurance plans would begin for plan years starting on or after January 1, 2027, with other rules taking effect at different times.
Main coverage requirement
Insurance plans must start covering infertility treatments for plan years beginning on or after January 1, 2027.
Notice to plan members
Health plans must start notifying their members about the new coverage starting with the second plan year after the bill becomes law.
Analysis of benefit management
For the first five plan years after the bill becomes law, insurance companies must analyze and report on how they apply management tools to these benefits.