Signed by Governor Chris Sununu

Vote Smart's Synopsis:

Vote to pass a bill that requires health insurers cover fertility treatment costs.

Highlights:

• Requires each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance that provides benefits for medical or hospital expenses to provide certificate holders of such insurance coverage for the diagnosis of infertility and for medically necessary fertility treatment (Sec. 2).

• Specifies that this treatment includes evaluations, laboratory assessments, medications, and treatments associated with the procurement of donor eggs, sperm, and embryos (Sec. 2).

• Defines “medically necessary” as health care services or products provided to an enrollee for the purpose of preventing, stabilizing, diagnosing, or treating an illness, injury, or disease in a manner that meeting the following standards (Sec. 2):

• Consistent with generally accepted standards of medical practice;

• Clinically appropriate in terms of type, frequency, extent, site, and duration;

• Demonstrated through scientific evidence to be effective in improving health outcomes;

• Representative of “best practices” in the medical profession; and

• Not primarily for the convenience of the enrollee or physician or other health provider.  

• Prohibits a health carrier from (Sec. 2):

• Imposing deductibles, copayments coinsurance, benefit maximums, waiting periods, or any limitations on coverage for required benefits which are different from those imposed upon benefits for services not related to infertility or any limitations on coverage of fertility medications that are different from those imposed on any other prescription medications;

• Imposing pre-existing condition exclusions or pre-existing condition waiting periods on coverage for required benefits, or use any prior diagnosis of prior treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits; or

• Imposing limitations on coverage based solely on arbitrary factors including but not limited to, number of attempts, dollar amounts, age, or to provide different benefits to a class different than other patients (Sec. 2)

Full Bill Text