SB 1228 Mandates coverage for fertility medications and requires insurers to offer coverage for other infertility services
LR Number:4942S.01I Fiscal Note:4942-01
Committee:Insurance and Housing
Last Action:03/20/02 - Hearing Conducted S Insurance & Housing Committee Journal page:
Effective Date:August 28, 2002
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Current Bill Summary

SB 1228 - This act mandates coverage for fertility medications and requires insurers to offer coverage for additional infertility services.

A new Section 376.1252 is created to require insurers to provide coverage for medically necessary expenses incurred for medications prescribed for the treatment of infertility. The policy must also allow a member to purchase additional coverage for other services related to the diagnosis and treatment of infertility.

In providing such additional coverage, the insurer may provide that coverage for in vitro fertilization, gamete intra fallopian transfer, and zygote intra fallopian transfer shall be limited to a covered person who: 1. Has used all reasonable, less expensive, and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; 2. Has not reached the limit of 4 completed egg retrievals; and 3. Is 45 years old or younger.

The act defines "infertility". Such benefits must be provided to the same extent as other pregnancy-related procedures, except that the services shall be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. This act does not apply to certain types of policies. Religious organizations are exempted if covering such procedures would violate their religious beliefs.

This act will be effective on January 1, 2003.