36 Section 1. Paragraph 6 of subsection (k) of section 3221 of the insur-
37 ance law, as added by chapter 897 of the laws of 1990, is amended to
38 read as follows:
39 (6) (A) Every group policy issued or delivered in this state which
40 provides coverage for hospital care shall not exclude coverage for
41 hospital care for diagnosis and treatment of correctable medical condi-
42 tions otherwise covered by the policy solely because the medical condi-
43 tion results in infertility; provided, however that:
44 (i) subject to the provisions of subparagraph (C) of this paragraph,
45 in no case shall such coverage exclude surgical or medical procedures
46 provided as part of such hospital care which would correct malformation,
47 disease or dysfunction resulting in infertility; and
48 (ii) provided, further however, that subject to the provisions of
49 subparagraph (C) of this paragraph, in no case shall such coverage
50 exclude diagnostic tests and procedures provided as part of such hospi-
51 tal care that are necessary to determine infertility or that are neces-
52 sary in connection with any surgical or medical treatments or
53 prescription drug coverage provided pursuant to this paragraph, includ-
54 ing such diagnostic tests and procedures as hysterosalpingogram, hyster-
S. 6257--B 64 A. 9759--B
1 oscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital
2 tests, testis biopsy, semen analysis, blood tests and ultrasound; and
3 (iii) provided, further however, every such policy which provides
4 coverage for prescription drugs shall include, within such coverage,
5 coverage for prescription drugs approved by the federal Food and Drug
6 Administration for use in the diagnosis and treatment of infertility in
7 accordance with subparagraph (C) of this paragraph.
8 (B) Every group policy issued or delivered in this state which
9 provides coverage for surgical and medical care shall not exclude cover-
10 age for surgical and medical care for diagnosis and treatment of correc-
11 table medical conditions otherwise covered by the policy solely because
12 the medical condition results in infertility; provided, however that:
13 (i) subject to the provisions of subparagraph (C) of this paragraph,
14 in no case shall such coverage exclude surgical or medical procedures
15 which would correct malformation, disease or dysfunction resulting in
16 infertility; and
17 (ii) provided, further however, that subject to the provisions of
18 subparagraph (C) of this paragraph, in no case shall such coverage
19 exclude diagnostic tests and procedures that are necessary to determine
20 infertility or that are necessary in connection with any surgical or
21 medical treatments or prescription drug coverage provided pursuant to
22 this paragraph, including such diagnostic tests and procedures as
23 hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy,
24 sono-hysterogram, post coital tests, testis biopsy, semen analysis,
25 blood tests and ultrasound; and
26 (iii) provided, further however, every such policy which provides
27 coverage for prescription drugs shall include, within such coverage,
28 coverage for prescription drugs approved by the federal Food and Drug
29 Administration for use in the diagnosis and treatment of infertility in
30 accordance with subparagraph (C) of this paragraph.
31 (C) Coverage of diagnostic and treatment procedures, including
32 prescription drugs, used in the diagnosis and treatment of infertility
33 as required by subparagraphs (A) and (B) of this paragraph shall be
34 provided in accordance with the provisions of this subparagraph.
35 (i) Coverage shall be provided for persons whose ages range from twen-
36 ty-one through forty-four years, provided that nothing herein shall
37 preclude the provision of coverage to persons whose age is below or
38 above such range.
39 (ii) Diagnosis and treatment of infertility shall be prescribed as
40 part of a physician's overall plan of care and consistent with the
41 guidelines for coverage as referenced in this subparagraph.
42 (iii) Coverage may be subject to co-payments, coinsurance and deduct-
43 ibles as may be deemed appropriate by the superintendent and as are
44 consistent with those established for other benefits within a given
45 policy.
46 (iv) Coverage shall be limited to those individuals who have been
47 previously covered under the policy for a period of not less than twelve
48 months, provided that for the purposes of this subparagraph "period of
49 not less than twelve months" shall be determined by calculating such
50 time from either the date the insured was first covered under the exist-
51 ing policy or from the date the insured was first covered by a previous-
52 ly in-force converted policy, whichever is earlier.
53 (v) Coverage shall not be required to include the diagnosis and treat-
54 ment of infertility in connection with: (I) in vitro fertilization,
55 gamete intrafallopian tube transfers or zygote intrafallopian tube
56 transfers; (II) the reversal of elective sterilizations; (III) sex
S. 6257--B 65 A. 9759--B
1 change procedures; (IV) cloning; or (V) medical or surgical services or
2 procedures that are deemed to be experimental in accordance with clin-
3 ical guidelines referenced in clause (vi) of this subparagraph.
4 (vi) The superintendent, in consultation with the commissioner of
5 health, shall promulgate regulations which shall stipulate the guide-
6 lines and standards which shall be used in carrying out the provisions
7 of this subparagraph, which shall include:
8 (I) The determination of "infertility" in accordance with the stand-
9 ards and guidelines established and adopted by the American College of
10 Obstetricians and Gynecologists and the American Society for Reproduc-
11 tive Medicine;
12 (II) The identification of experimental procedures and treatments not
13 covered for the diagnosis and treatment of infertility determined in
14 accordance with the standards and guidelines established and adopted by
15 the American College of Obstetricians and Gynecologists and the American
16 Society for Reproductive Medicine;
17 (III) The identification of the required training, experience and
18 other standards for health care providers for the provision of proce-
19 dures and treatments for the diagnosis and treatment of infertility
20 determined in accordance with the standards and guidelines established
21 and adopted by the American College of Obstetricians and Gynecologists
22 and the American Society for Reproductive Medicine; and
23 (IV) The determination of appropriate medical candidates by the treat-
24 ing physician in accordance with the standards and guidelines estab-
25 lished and adopted by the American College of Obstetricians and Gynecol-
26 ogists and/or the American Society for Reproductive Medicine.
27 § 2. Subsection (s) of section 4303 of the insurance law, as added by
28 chapter 897 of the laws of 1990 and as relettered by chapter 131 of the
29 laws of 1992, is amended to read as follows:
30 (s) (1) A hospital service corporation or health service corporation
31 which provides coverage for hospital care shall not exclude coverage for
32 hospital care for diagnosis and treatment of correctable medical condi-
33 tions otherwise covered by the policy solely because the medical condi-
34 tion results in infertility; provided, however that:
35 (A) subject to the provisions of paragraph three of this subsection,
36 in no case shall such coverage exclude surgical or medical procedures
37 provided as part of such hospital care which would correct malformation,
38 disease or dysfunction resulting in infertility; and
39 (B) provided, further however, that subject to the provisions of para-
40 graph three of this subsection, in no case shall such coverage exclude
41 diagnostic tests and procedures provided as part of such hospital care
42 that are necessary to determine infertility or that are necessary in
43 connection with any surgical or medical treatments or prescription drug
44 coverage provided pursuant to this subsection, including such diagnostic
45 tests and procedures as hysterosalpingogram, hysteroscopy, endometrial
46 biopsy, laparoscopy, sono-hysterogram, post coital tests, testis biopsy,
47 semen analysis, blood tests and ultrasound; and
48 (C) provided, further however, every such policy which provides cover-
49 age for prescription drugs shall include, within such coverage, coverage
50 for prescription drugs approved by the federal Food and Drug Adminis-
51 tration for use in the diagnosis and treatment of infertility in accord-
52 ance with paragraph three of this subsection.
53 (2) A medical expense indemnity or health service corporation which
54 provides coverage for surgical and medical care shall not exclude cover-
55 age for surgical and medical care for diagnosis and treatment of correc-
S. 6257--B 66 A. 9759--B
1 table medical conditions otherwise covered by the policy solely because
2 the medical condition results in infertility; provided, however that:
3 (A) subject to the provisions of paragraph three of this subsection,
4 in no case shall such coverage exclude surgical or medical procedures
5 which would correct malformation, disease or dysfunction resulting in
6 infertility; and
7 (B) provided, further however, that subject to the provisions of para-
8 graph three of this subsection, in no case shall such coverage exclude
9 diagnostic tests and procedures that are necessary to determine infer-
10 tility or that are necessary in connection with any surgical or medical
11 treatments or prescription drug coverage provided pursuant to this
12 subsection, including such diagnostic tests and procedures as hystero-
13 salpingogram, hysteroscopy, endometrial biopsy, laparoscopy, sono-hyste-
14 rogram, post coital tests, testis biopsy, semen analysis, blood tests
15 and ultrasound; and
16 (C) provided, further however, every such policy which provides cover-
17 age for prescription drugs shall include, within such coverage, coverage
18 for prescription drugs approved by the federal Food and Drug Adminis-
19 tration for use in the diagnosis and treatment of infertility in accord-
20 ance with paragraph three of this subsection.
21 (3) Coverage of diagnostic and treatment procedures, including
22 prescription drugs used in the diagnosis and treatment of infertility as
23 required by paragraphs one and two of this subsection shall be provided
24 in accordance with this paragraph.
25 (A) Coverage shall be provided for persons whose ages range from twen-
26 ty-one through forty-four years, provided that nothing herein shall
27 preclude the provision of coverage to persons whose age is below or
28 above such range.
29 (B) Diagnosis and treatment of infertility shall be prescribed as part
30 of a physician's overall plan of care and consistent with the guidelines
31 for coverage as referenced in this paragraph.
32 (C) Coverage may be subject to co-payments, coinsurance and deduct-
33 ibles as may be deemed appropriate by the superintendent and as are
34 consistent with those established for other benefits within a given
35 policy.
36 (D) Coverage shall be limited to those individuals who have been
37 previously covered under the policy for a period of not less than twelve
38 months, provided that for the purposes of this paragraph "period of not
39 less than twelve months" shall be determined by calculating such time
40 from either the date the insured was first covered under the existing
41 policy or from the date the insured was first covered by a previously
42 in-force converted policy, whichever is earlier.
43 (E) Coverage shall not be required to include the diagnosis and treat-
44 ment of infertility in connection with: (i) in vitro fertilization,
45 gamete intrafallopian tube transfers or zygote intrafallopian tube
46 transfers; (ii) the reversal of elective sterilizations; (iii) sex
47 change procedures; (iv) cloning; or (v) medical or surgical services or
48 procedures that are deemed to be experimental in accordance with clin-
49 ical guidelines referenced in subparagraph (F) of this paragraph.
50 (F) The superintendent, in consultation with the commissioner of
51 health, shall promulgate regulations which shall stipulate the guide-
52 lines and standards which shall be used in carrying out the provisions
53 of this paragraph, which shall include:
54 (i) The determination of "infertility" in accordance with the stand-
55 ards and guidelines established and adopted by the American College of
S. 6257--B 67 A. 9759--B
1 Obstetricians and Gynecologists and the American Society for Reproduc-
2 tive Medicine;
3 (ii) The identification of experimental procedures and treatments not
4 covered for the diagnosis and treatment of infertility determined in
5 accordance with the standards and guidelines established and adopted by
6 the American College of Obstetricians and Gynecologists and the American
7 Society for Reproductive Medicine;
8 (iii) The identification of the required training, experience and
9 other standards for health care providers for the provision of proce-
10 dures and treatments for the diagnosis and treatment of infertility
11 determined in accordance with the standards and guidelines established
12 and adopted by the American College of Obstetricians and Gynecologists
13 and the American Society for Reproductive Medicine; and
14 (iv) The determination of appropriate medical candidates by the treat-
15 ing physician in accordance with the standards and guidelines estab-
16 lished and adopted by the American College of Obstetricians and Gynecol-
17 ogists and/or the American Society for Reproductive Medicine.
18 § 3. Subdivision 1 of section 2807-v of the public health law is
19 amended by adding a new paragraph (ii) to read as follows:
20 (ii) Funds shall be reserved and accumulated from year to year by the
21 commissioner and shall be available, including income from invested
22 funds, for the purposes of a grant program to improve access to infer-
23 tility services, treatments and procedures, from the tobacco control and
24 insurance initiatives pool established for the period January first, two
25 thousand two through December thirty-first, two thousand two in the
26 amount of ten million dollars.
27 § 4. The commissioner of health, subject to the availability of funds
28 pursuant to section 2807-v of the public health law, shall establish a
29 program to provide grants to health care providers for the purpose of
30 improving access to infertility services, treatments and procedures. At
31 least one such provider shall be located in the city of New York and one
32 such provider shall be located in an upstate region.
33 Such program shall be targeted to assist individuals in meeting the
34 cost of infertility services not covered pursuant to sections 3221 and
35 4303 of the insurance law as such sections are amended by sections one
36 and two of this act relating to expanded coverage of infertility
37 services. Services, treatments and procedures paid for pursuant to the
38 grant program shall be limited to those who meet the criteria for such
39 expanded coverage provided pursuant to the insurance law but for whom
40 the covered services are not effective for treating infertility.
41 Services, treatments and procedures paid for pursuant to the grant
42 program shall be further limited to assisted reproductive technology
43 utilizing in vitro fertilization and gamete intrafallopian tube trans-
44 fer, and shall be made available only in accordance with standards,
45 protocols and other parameters as shall be established by the commis-
46 sioner, which shall include but not be limited to ASRM and ACOG stand-
47 ards for the appropriateness of individuals, providers and treatments,
48 and standards relating to cost-sharing based on income. Services, treat-
49 ments and procedures under the grant program, except for those specified
50 herein, shall not include those services, treatments and procedures
51 explicitly excluded under the expanded coverage provided for in the
52 insurance law as amended by sections one and two of this act. Notwith-
53 standing sections 112 and 163 of the state finance law, grants provided
54 pursuant to such program may be made without competitive bid or request
55 for proposal.
S. 6257--B 68 A. 9759--B
1 The commissioner of health shall promote public awareness of this
2 program.
3 § 5. This act shall take effect September 1, 2002 and shall apply to
4 all policies and contracts issued, renewed or modified on or after such
5 date; provided, however, effective immediately the superintendent of
6 insurance is authorized and directed to promulgate any regulations
7 necessary for the implementation of the provisions of this act.
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