[First Reprint]
SENATE, No. 1196
STATE OF NEW JERSEY
INTRODUCED MAY 30, 1996
By Senators MARTIN, Ewing and Schluter
An Act requiring health insurers to provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility and supplementing Title 17 of the Revised Statutes, Title 17B of the New Jersey Statutes and P.L.1973, c.337 (C.26:2J-1 et seq.)
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. 1[No] A1 hospital service corporation 1[contract providing] which provides1 hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, shall 1[be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides] offer1 coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility 1as provided pursuant to this section1. 1A hospital service corporation shall offer coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The hospital service corporation 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: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.1
For purposes of this section, "infertility" means the 1disease or1 condition 1[of a presumably healthy individual who is unable to conceive or produce conception during a period of one year] that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse; or carry a pregnancy to live birth1. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract 1, except that the services provided for in 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 Gynecologists1.
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. 1[No] A1 medical service corporation 1[contract providing] which provides1 hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, shall 1[be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides] offer1 coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility 1as provided pursuant to this section1. 1A medical service corporation shall offer coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The medical service corporation 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: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.1
For purposes of this section, "infertility" means the 1disease or1 condition 1[of a presumably healthy individual who is unable to conceive or produce conception during a period of one year] that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse; or carry a pregnancy to live birth1. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract 1, except that the services provided for in 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 Gynecologists1.
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. 1[No] A1 health service corporation 1[contract providing] which provides1 hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, shall 1[be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides] offer1 coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility 1as provided pursuant to this section1. 1A health service corporation shall offer coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. The health service corporation 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: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.1
For purposes of this section, "infertility" means the 1disease or1 condition 1[of a presumably healthy individual who is unable to conceive or produce conception during a period of one year] that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse; or carry a pregnancy to live birth1. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract 1, except that the services provided for in 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 Gynecologists1.
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. 1[No] A1 group health 1[insurance policy providing] insurer which provides1 hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, shall 1[be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the policy provides] offer1 coverage to any named insured or other person covered under the 1[contract] policy1 for medically necessary expenses incurred in the diagnosis and treatment of infertility 1as provided pursuant to this section1. 1An insurer shall offer coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the covered person. 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: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.1
For purposes of this section, "infertility" means the 1disease or1 condition 1[of a presumably healthy individual who is unable to conceive or produce conception during a period of one year] that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse; or carry a pregnancy to live birth1. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the policy 1, except that the services provided for in 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 Gynecologists1.
This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium.
5. A 1[certificate of authority to establish and operate a]1 health maintenance organization 1[in this State shall not be issued or continued by the Commissioner of Health on or after the effective date of this act unless the health maintenance organization offers] shall offer1 health care services, for groups of more than 49 enrollees, for medically necessary expenses incurred in the diagnosis and treatment of infertility 1as provided pursuant to this section1. 1A health maintenance organization shall offer enrollee coverage which includes, but is not limited to, the following services related to infertility: diagnosis and diagnostic tests; medications; surgery; in vitro fertilization; embryo transfer; artificial insemination; gamete intra fallopian transfer; zygote intra fallopian transfer; intracytoplasmic sperm injection; and four completed egg retrievals per lifetime of the enrollee. The health maintenance organization may provide that health care services for in vitro fertilization, gamete intra fallopian transfer and zygote intra fallopian transfer shall be limited to a covered person who: a. has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; b. has not reached the limit of four completed egg retrievals; and c. is 45 years of age or younger.1
For the purposes of this section, "infertility" means the 1disease or1 condition 1[of a presumably healthy individual who is unable to conceive or produce conception during a period of one year] that results in the abnormal function of the reproductive system such that a person is not able to: impregnate another person; conceive after two years of unprotected intercourse; or carry a pregnancy to live birth1. The health care services shall be provided to the same extent as for other pregnancy-related procedures under the contract 1, except that the services provided for in 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 Gynecologists1.
The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
6. This act shall take effect on the 30th day after enactment.
Requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility.