AN ACT Relating to Health Benefit Plan Coverage of Infertility

UNOFFICIAL COPY AS OF 10/14/1803 REG. SESS.03 RS BR 1265

AN ACT relating to health benefit plan coverage of infertility.

Be it enacted by the General Assembly of the Commonwealth of Kentucky:

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BR126500.100-1265

UNOFFICIAL COPY AS OF 10/14/1803 REG. SESS.03 RS BR 1265

SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ AS FOLLOWS:

(1)A health benefit plan issued or renewed on or after the effective date of this Act that provides pregnancy-related benefits shall contain coverage for the diagnosis and treatment of infertility including, but not limited to, the following:

(a)Diagnosis and diagnostic tests;

(b)Medications;

(c)Surgery;

(d)In vitro fertilization;

(e)Uterine embryolavage;

(f)Embryo transfer;

(g)Artificial insemination;

(h)Gamete intrafallopian tube transfer;

(i)Zygote intrafallopian tube transfer;

(j)Intracytoplasmic sperm injection;

(k)Four (4) completed egg retrievals per lifetime, except as may be allowed under subsection (2)(b) of this section; and

(l)Low tubal ovum transfer.

(2)The coverage required under subsection (1) of this section may be subject to the conditions set out in this subsection. Coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer may be required only if:

(a)The covered individual has been unable to attain or sustain a successful pregnancy through reasonable, less costly medically appropriate infertility treatments for which coverage is available under the policy, plan, or contract;

(b)The covered individual has not undergone four (4) completed egg retrievals, except that if a live birth follows a completed egg retrieval, then two (2) more completed egg retrievals shall be covered; and

(c)The covered individual is forty-five (45) years of age or younger.

(3)The procedures required to be covered under this section shall not be required to be contained in any policy or plan issued to or by a religious institution or organization or to or by an entity sponsored by a religious institution or organization that finds the procedures required to be covered under this section to violate its religious and moral teachings and beliefs.

(4)The covered benefits provided under this section shall be to the same extent as for other pregnancy-related procedures under the health benefit plan, except that the services provided under this section 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.

(5)For purposes of this section, "infertility" means the disease or condition that results in the abnormal function of the reproductive system such that a person is not able to:

(a)Impregnate another person;

(b)Conceive after one (1) year of unprotected sexual intercourse; or

(c)Carry a pregnancy to live birth.

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BR126500.100-1265