This bill would change the Affordable Care Act to make fertility treatment and care an essential health benefit. It defines fertility treatment and care to include egg, sperm, or embryo preservation; artificial insemination; assisted reproductive technology such as in vitro fertilization (IVF); genetic testing of embryos; fertility medications; gamete donation; and other related services the Secretary of Health and Human Services finds appropriate. The bill requires that plans in the individual and small group markets that offer medical and surgical benefits must cover these fertility benefits. It specifies at least 3 complete oocyte retrievals and unlimited embryo transfers from those retrievals, follows American Society for Reproductive Medicine guidelines, and calls for single embryo transfer when recommended and medically appropriate.
The bill also requires parity: cost sharing and treatment limits for fertility benefits must be no more restrictive than those applied to most other medical and surgical benefits in the plan. Insurers may not deny fertility benefits because a person does not have a diagnosis of infertility. Plans that use utilization management tools for fertility care must analyze and report how those tools are applied; the Comptroller General must compile and publish a summary report. The changes would apply to plan years starting 1 year after the law is enacted.
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