No CRS summary available for this bill.
This section amends ERISA (29 U.S.C. 1185 et seq.) to require group health plans and health insurance issuers offering group health coverage that provide obstetrical services to cover infertility and iatrogenic infertility treatments, including standard fertility preservation services when caused by medically necessary surgery or invasive procedures, radiation therapy, chemotherapy, or myeloablative conditioning. It defines infertility as the inability to achieve spontaneous pregnancy after at least 12 consecutive months of unprotected intercourse (or other specified clinical criteria); iatrogenic infertility as fertility impairment from damage to reproductive organs or processes due to the listed medical interventions; and infertility treatments as procedures to facilitate pregnancy such as in vitro fertilization, cryopreservation, intracytoplasmic sperm injection, ovulation induction, genetic screening, sperm cryopreservation, and intrauterine insemination. Coverage must be comprehensive (as determined by the Secretary in consultation with stakeholders), provided at facilities compliant with federal and state standards, and subject to utilization limits and cost-sharing (e.g., coinsurance, copayments, deductibles, medical necessity, pre-authorization) no more restrictive than those applied to substantially all medical and surgical benefits. Plans and issuers are prohibited from (1) offering incentives to forgo entitled treatments, (2) restricting providers from discussing covered options, or (3) penalizing providers for furnishing such services; however, nothing requires individuals to undergo treatment, affects utilization management tools, or limits provider contracting. Plans imposing utilization management on these benefits must comply with specified requirements for the first five plan years after enactment.