110 HR 2892 IH: Family U.S. House of Representatives 2007-06-27 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 110th CONGRESS 1st Session H. R. 2892 IN THE HOUSE OF REPRESENTATIVES June 27, 2007 Mr. Weiner (for himself and Ms. Wasserman Schultz) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Oversight and Government Reform, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, chapter 89 of title 5, United States Code, and title 10, United States Code, to require coverage for the treatment of infertility.

1.

Short title; findings

(a)

Short title

This Act may be cited as the Family Building Act of 2007. (b)

Findings

Congress makes the following findings: (1)Infertility is a disease affecting more than 6,000,000 American women and men, about 10 percent of the reproductive age population. (2)Recent improvements in therapy make pregnancy possible for more couples than in past years. (3)The majority of group health plans do not provide coverage for infertility therapy. (4)A fundamental part of the human experience is fulfilling the desire to reproduce.

2.

Standards relating to benefits for treatment of infertility

(a)

Group health plans

(1)

Public Health Service Act amendment

(A)Subpart 2 of part A of title XXVII of the Public Health Service Act is amended by adding at the end the following new section:

2707.

Standards relating to benefits for treatment of infertility

(a)

Requirements for coverage of treatment of infertility

(1)

In general

In a case in which a group health plan, and a health insurance issuer offering group health insurance coverage provides coverage for obstetrical services, such plan or issuer shall include (consistent with this section) coverage for treatment of infertility. (2)

Infertility defined

For purposes of this section, the term infertility means a disease or condition that results in the abnormal function of the reproductive system, which results in— (A)the inability to conceive after 1 year of unprotected intercourse, or (B)the inability to carry a pregnancy to live birth. (b)

Required coverage

(1)

In general

A group health plan, and a health insurance issuer offering group health insurance coverage shall provide coverage for treatment of infertility deemed appropriate by a participant or beneficiary and the treating physician. Such treatment shall include ovulation induction, artificial insemination, in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), and any other treatment provided it has been deemed as non-experimental by the Secretary of Health and Human Services after consultation with appropriate professional and patient organizations such as the American Society for Reproductive Medicine, RESOLVE, and the American College of Obstetricians and Gynecologists. (2)

Limitation on coverage of assisted reproductive technology

(A)

In general

In the case of assisted reproductive technology, coverage shall be provided if— (i)the participant or beneficiary has been unable to bring a pregnancy to a live birth through less costly medically appropriate infertility treatments for which coverage is available under the insured’s policy, plan, or contract; (ii)the participant or beneficiary has not undergone 4 complete oocyte retrievals, except that if a live birth follows a completed oocyte retrieval, then at least 2 more completed oocyte retrievals shall be covered, with a lifetime cap of 6 retrievals; and (iii)the treatment is performed at a medical facility that— (I)conforms to the standards of the American Society for Reproductive Medicine; and (II)is in compliance with any standards set by an appropriate Federal agency. (B)

Definition of assisted reproductive technology

For purposes of this paragraph, the term assisted reproductive technology includes all treatments or procedures that involve the handling of human egg and sperm for the purpose of helping a woman become pregnant. Types of Assisted Reproductive Technology include in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, embryo cryopreservation, egg or embryo donation, and surrogate birth. (3)

Review by the Secretary of Health and Human Services

Not later than 5 years after the date of enactment of the Family Building Act of 2007, the Secretary of Health and Human Services, in consultation with the American Society for Reproductive Medicine and RESOLVE: the National Infertility Association, shall review the requirements for treatment of infertility established under paragraphs (1) and (2). (c)

Limitation

Deductibles, coinsurance, and other cost-sharing or other limitations for infertility therapy may not be imposed to the extent they exceed the deductibles, coinsurance, and limitations that are applied to similar services under the group health plan or health insurance coverage. (d)

Prohibitions

A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not— (1)deny to a participant or beneficiary eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; (2)provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to be provided infertility treatments to which they are entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries; (3)prohibit a provider from discussing with a participant or beneficiary infertility treatment techniques or medical treatment options relating to this section; or (4)penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility treatments to a qualified participant or beneficiary in accordance with this section. (e)

Rule of construction

Nothing in this section shall be construed to require a participant or beneficiary to undergo infertility therapy. (f)

Notice

A group health plan under this part shall comply with the notice requirement under section 713(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan. (g)

Level and type of reimbursements

Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. (h)

Preemption

The provisions of this section do not preempt State law relating to health insurance coverage to the extent such State law provides greater benefits with respect to infertility treatments or prevention.

. (B)Section 2723(c) of such Act (42 U.S.C. 300gg–23(c)) is amended by striking section 2704 and inserting sections 2704 and 2707. (2)

ERISA amendment

(A)Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section:

714.

Standards relating to benefits for treatment of infertility

(a)

In general

A group health plan and a health insurance issuer offering group health insurance coverage in connection with such a plan shall comply with the requirements of section 2707 of the Public Health Service Act, and such requirements shall be deemed to be incorporated into this subsection. (b)

Notice

A health insurance issuer offering health insurance coverage in connection with a group health plan shall comply with the notice requirement under section 713(b) with respect to the requirements referred to in subsection (a) as if such section applied to such issuer and such issuer were a group health plan.

. (B)Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking section 711 and inserting sections 711 and 714. (C)The table of contents in section 1 of such Act is amended by inserting after the item relating to section 713 the following new item: 714. Standards relating to benefits for treatment of infertility. . (b)

Individual health insurance

(1)Part B of title XXVII of the Public Health Service Act is amended by inserting after section 2752 the following new section:

2753.

Standard relating to benefits for treatment of infertility

(a)

In general

The provisions of section 2707 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market. (b)

Notice

A health insurance issuer under this part shall comply with the notice requirement under section 713(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements referred to in subsection (a) as if such section applied to such issuer and such issuer were a group health plan.

. (2)Section 2762(b)(2) of such Act (42 U.S.C. 300gg–62(b)(2)) is amended by striking section 2751 and inserting sections 2751 and 2753. (c)

Effective dates

(1)

Group health plans and group health insurance coverage

Subject to paragraph (3), the amendments made by subsection (a) apply with respect to group health plans for plan years beginning on or after the date occurring 6 months after the date of the enactment of this Act. (2)

Individual health insurance coverage

The amendments made by subsection (b) apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after such date. (3)

Collective bargaining exception

In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of enactment of this Act, the amendments made by subsection (a) shall not apply to plan years beginning before the later of— (A)the date on which the last collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of enactment of this Act), or (B)the date occurring 6 months after the date of the enactment of this Act. For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by subsection (a) shall not be treated as a termination of such collective bargaining agreement.

3.

Amendment to title 5, United States Code

(a)

In general

Section 8902 of title 5, United States Code, is amended by adding at the end the following new subsection: (p)(1)Each contract under this chapter which provides obstetrical benefits shall also provide (in a manner consistent with section 2707 of the Public Health Service Act) coverage for the diagnosis and treatment of infertility (as defined by such section). (2)Subsection (m)(1) shall not, with respect to any contract under this chapter, prevent the inclusion of any terms which, under paragraph (1), are required by reason of section 2707(h) of the Public Health Service Act. . (b)

Effective date

The amendment made by this section shall apply with respect to contracts entered into or renewed for contract years beginning at least 6 months after the date of enactment of this Act.

4.

Defense health care plans

(a)

In general

(1)Chapter 55 of title 10, is amended by inserting after section 1099 the following new section:

1099a.

Health care plans: obstetrical and infertility benefits

(a)

In general

Any health care plan under this chapter that provides obstetrical benefits shall also provide (in a manner consistent with section 2707 of the Public Health Service Act) coverage for the diagnosis and treatment of infertility (as defined by such section). (b)

Regulations

The Secretary of Defense shall precribe any regulations necessary to carry out this section.

. (2)The table of sections at the beginning of such chapter is amended by adding at the end the following new item: 1099a. Health care plans: obstetrical and infertility benefits. . (b)

Effective date

The amendment made by this section shall apply with respect to contracts entered into or renewed for contract years beginning at least 6 months after the date of enactment of this Act.