AB 989

This bill requires health insurance coverage of the diagnosis and treatment of

infertility.

The bill requires health care plans that provide maternity coverage to provide

coverage of any nonexperimental procedure for the diagnosis or treatment of

infertility, which under the bill is the inability to conceive or produce conception after

at least one year of unprotected intercourse if the female is under age 35 or after at

least six months of unprotected intercourse if the female is between ages 35 and 42,

the inability to conceive after undergoing three or more cycles of infertility

treatments, or the inability to carry a pregnancy to live birth.

The bill requires that certain conditions be satisfied for coverage of procedures

in connection with in vitro fertilization and specifies that, if those conditions are

satisfied, the procedures that must be covered in connection with in vitro fertilization

are up to three egg retrievals performed on an insured under age 42; all single

embryo transfers that result from covered retrievals and that are performed on an

insured under age 35; all double embryo transfers that result from covered retrievals

and that are performed on an insured between ages 35 and 42; and up to five embryo

transfers to an insured of embryos not resulting from covered retrievals. The bill

provides that an egg retrieval is required to be covered only if all high quality

embryos resulting from any previous covered egg retrieval have been used in embryo

transfers performed on the insured. In addition, if the eggs retrieved under a covered

retrieval are of poor quality, a health care plan must cover all double embryo

transfers to an insured under age 35 and all triple embryo transfers to an insured

between ages 35 and 42.

The coverage requirement applies to all health care plans that provide

maternity coverage, including individual health insurance policies and group health

plans, health maintenance organizations, preferred provider plans, plans of

cooperative sickness care associations, plans offered by the state to its employees,

and self-insured plans of counties, cities, towns, villages, and school districts.

Excluded from the requirement is health care provided to Medical Assistance

recipients.

The bill provides that copayments and deductibles for the infertility coverage

may not be greater than any copayments or deductibles for the maternity coverage

under the health care plan. The bill also provides that the coverage required for

procedures in connection with in vitro fertilization is the lifetime maximum coverage

for any insured under all health care plans covering that insured during her lifetime.