Mandated Benefits Review - Senate Bill 1183 - Overview

Senate Bill 1183 would require every health insurance policy that provides pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility.

Infertility is defined in the bill as the inability to conceive after one year of unprotected intercourse, or the inability to sustain a successful pregnancy.

Among the specific treatments outlined by the act are:

Coverage is not, however, limited to these specific treatments.

The coverage would be required under the following conditions:

  1. Coverage may not be subject to copayments or deductibles which are greater than those applied to pregnancy-related benefits under the same policy.
  2. Coverage for in vitro fertilization, gamete intrafallopian tube transfer or zygote intrafallopian tube transfer is only required if the covered individual has been unable to attain or sustain a pregnancy through reasonable, less costly medically appropriate infertility treatments for which coverage is available.
  3. The covered individual may undergo four completed oocyte retrievals, except that, if a live birth follows a complete oocyte retrieval, then two more complete oocyte retrievals will be covered.
  4. The procedures must be performed at medical facilities which conform to the American College of Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization.

Religious institutions or organizations may choose not to offer infertility benefits if it violates its religious and moral teachings and beliefs.

As a state law, the measure would be preempted by the federal Employee Retirement Income Security Act of 1974 (ERISA) (PL 93-406), which precludes state laws from applying to the benefit plans of self-insured companies. The percentage of private payers that are preempted by ERISA is estimated to be 50% of the privately insured.