Sponsored by:
Senator NILSA CRUZ-PEREZ
District 5 (Camden and Gloucester)
Senator M. TERESA RUIZ
District 29 (Essex)
Assemblywoman PAMELA R. LAMPITT
District 6 (Burlington and Camden)
Assemblywoman BRITNEE N. TIMBERLAKE
District 34 (Essex and Passaic)
Assemblywoman GABRIELA M. MOSQUERA
District 4 (Camden and Gloucester)
Assemblywoman SHAVONDA E. SUMTER
District 35 (Bergen and Passaic)
Assemblywoman CLEOPATRA G. TUCKER
District 28 (Essex)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Co-Sponsored by:
Senators Beach, Greenstein, Pou, Assemblywomen Pintor Marin and Downey
SYNOPSIS
Mandates health benefits coverage for fertility preservation services under certain health insurance plans.
CURRENT VERSION OF TEXT
As reported by the Senate Commerce Committee on December 3, 2018, with amendments.
An Act concerning health benefits coverage for fertility preservation services under certain health insurance plans and supplementing various parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract which provides hospital or medical expense benefits for groups with 1more than1 50 1[or more]1 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. A hospital service corporation providing coverage under this section shall not determine the provision of standard fertility preservation services based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
c. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract which provides hospital or medical expense benefits for groups with 1more than1 50 1[or more]1 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. A medical service corporation providing coverage under this section shall not determine the provision of standard fertility preservation services based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
c. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract which provides hospital or medical expense benefits for groups with 1more than1 50 1[or more]1 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. A health service corporation providing coverage under this section shall not determine the provision of standard fertility preservation services based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
c. This section shall
apply to those health service corporation contracts in which the health service
corporation has reserved the right to change the premium.
4. a. A group health insurance policy which provides hospital or medical expense benefits for groups with 1more than1 50 1[or more]1 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the policy. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the policy.
b. An insurer providing coverage under this section shall not determine the provision of standard fertility preservation services based on an insured’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
c. This section shall apply to those group health insurance policies in which the insurer has reserved the right to change the premium.
5. a. A health maintenance organization contract that provides hospital or medical expense benefits for groups with 1more than1 50 1[or more]1 persons and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. A health maintenance organization providing coverage under this section shall not determine the provision of standard fertility preservation services based on an enrollee’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
c. This section shall apply to those health maintenance organization contracts in which the health maintenance organization has reserved the right to change the premium.
6. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. The State Health Benefits Commission shall not purchase a contract that determines the provision of standard fertility preservation services based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
7. a. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
For the purposes of this section:
“Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
“May directly or indirectly cause” means a medical treatment with a likely side effect of iatrogenic infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization] as defined by the New Jersey Department of Health1.
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or 1[other reputable professional organization that save or protect the oocytes, sperm, or reproductive tissue of a patient, including, but not limited to: embryo cryopreservation, oocyte and sperm cryopreservation, gonadal shielding, and ovarian transposition] as defined by the New Jersey Department of Health1. 1“Standard fertility preservation services” shall not include the storage of sperm or oocytes.1
The benefits shall be provided to the same extent as for any other medical condition under the contract. The same copayments, deductibles, and benefit limits shall apply to the provision of standard fertility preservation services pursuant to this section as those applied to other medical or surgical benefits under the contract.
b. The School Employees’ Health Benefits Program shall not purchase a contract that determines the provision of standard fertility preservation services based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.
8. This act shall take effect on the 90th day after enactment.