Standards relating to benefits for assisted reproductive technology and intrauterine insemination

(a) In general (1) PHSA Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following: 2799A–12. Standards relating to benefits for assisted reproductive technology and intrauterine insemination (a) In general A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide coverage for assisted reproductive technology and intrauterine insemination. (b) Definition (1) Assisted reproductive technology; ART The term assisted reproductive technology or ART means any treatment or procedure that includes the handling of human eggs or embryos to help achieve a pregnancy, including in vitro fertilization, egg or embryo cryopreservation, and egg or embryo donation. Such term includes any medication related to such a treatment or procedure. (2) Intrauterine insemination; IUI The term intrauterine insemination or IUI means a procedure that places sperm directly into an individual’s uterus at the time of the individual’s ovulation to increase the chances of fertilization. Such term includes any medication associated with such a procedure. (c) Required coverage A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for ART and IUI determined appropriate by the health care provider, regardless of whether the participant, beneficiary, or enrollee receiving ART or IUI has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the ART or IUI is performed at, or prescribed by, a licensed medical facility. (d) Limitation Cost-sharing, including deductibles and coinsurance, or other limitations for ART or IUI may not be imposed with respect to ART or IUI required to be covered under subsection (c) to the extent that such cost-sharing exceeds the cost-sharing applied to other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to ART or IUI. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. (e) Prohibitions A group health plan and a health insurance issuer offering group or individual health insurance coverage may not— (1) provide incentives (monetary or otherwise) to a participant, beneficiary, or enrollee to encourage such participant, beneficiary, or enrollee not to seek or obtain ART or IUI to which such participant, beneficiary, or enrollee is entitled under this section or to providers to induce such providers not to provide medically appropriate ART or IUI to participants, beneficiaries, or enrollees; (2) prohibit a provider from discussing with a participant, beneficiary, or enrollee ART or IUI relating to this section; (3) penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided ART or IUI to a qualified participant, beneficiary, or enrollee in accordance with this section; or (4) on the ground prohibited under title VI of the Civil Rights Act of 1964, title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, section 504 of the Rehabilitation Act of 1973, or section 1557 of the Patient Protection and Affordable Care Act, exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. (f) Rule of construction Nothing in this section shall be construed to require a participant, beneficiary, or enrollee to undergo ART or IUI. (g) Notice A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide notice to each participant, beneficiary, and enrollee under such plan or coverage regarding the coverage required by this section in accordance with regulations promulgated by the Secretary. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted— (1) not later than the earlier of— (A) in the first standard mailing made by the plan or issuer to the participant, beneficiary, or enrollee following the effective date of such regulations; (B) as part of any yearly informational packet sent to the participant, beneficiary, or enrollee; or (C) January 1, 2027; (2) in the case of a participant, beneficiary, or enrollee not enrolled in the plan or coverage on the date of transmission under paragraph (1), upon initial enrollment of such participant, beneficiary, or enrollee; and (3) on an annual basis after the transmission under paragraph (1) or (2). (h) Level and type of reimbursements Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.. (2) ERISA (A) In general Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: 727. Standards relating to benefits for assisted reproductive technology and intrauterine insemination (a) In general A group health plan or a health insurance issuer offering group health insurance coverage shall provide coverage for assisted reproductive technology and intrauterine insemination. (b) Definitions (1) Assisted reproductive technology or ART The term assisted reproductive technology or ART means any treatment or procedure that includes the handling of human eggs or embryos to help achieve a pregnancy, including in vitro fertilization, egg or embryo cryopreservation, and egg or embryo donation. Such term includes any medication related to such a treatment or procedure. (2) Intrauterine insemination; IUI The term intrauterine insemination or IUI means a procedure that places sperm directly into an individual’s uterus at the time of the individual’s ovulation to increase the chances of fertilization. Such term includes any medication associated with such a procedure. (c) Required coverage A group health plan and a health insurance issuer offering group health insurance coverage shall provide coverage for ART and IUI determined appropriate by the health care provider, regardless of whether the participant or beneficiary receiving ART or IUI has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the ART or IUI is performed at, or prescribed by, a licensed medical facility. (d) Limitation Cost-sharing, including deductibles and coinsurance, or other limitations for ART or IUI may not be imposed with respect to ART or IUI required to be covered under subsection (c) to the extent that such cost-sharing exceeds the cost-sharing applied to other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to ART or IUI. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. (e) Prohibitions A group health plan and a health insurance issuer offering group health insurance coverage may not— (1) provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to seek or obtain ART or IUI to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide medically appropriate ART or IUI to participants or beneficiaries; (2) prohibit a provider from discussing with a participant or beneficiary ART or IUI relating to this section; (3) penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided ART or IUI to a qualified participant or beneficiary in accordance with this section; or (4) on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116), exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. (f) Rule of construction Nothing in this section shall be construed to require a participant or beneficiary to undergo ART or IUI. (g) Notice A group health plan and a health insurance issuer offering group health insurance coverage shall provide notice to each participant and beneficiary under such plan or coverage regarding the coverage required by this section in accordance with regulations promulgated by the Secretary. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted— (1) not later than the earlier of— (A) in the first standard mailing made by the plan or issuer to the participant or beneficiary following the effective date of such regulations; (B) as part of any yearly informational packet sent to the participant or beneficiary; or (C) January 1, 2027; (2) in the case of a participant or beneficiary not enrolled in the plan or coverage on the date of transmission under paragraph (1), upon initial enrollment of such participant or beneficiary; and (3) on an annual basis after the transmission under paragraph (1) or (2). (h) Level and type of reimbursements Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.. (B) Clerical amendment The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 726 the following new item: Sec. 727. Standards relating to benefits for assisted reproductive technology and intrauterine insemination.. (3) IRC (A) In general Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: 9827. Standards relating to benefits for assisted reproductive technology and intrauterine insemination (a) In general A group health plan shall provide coverage for assisted reproductive technology and intrauterine insemination. (b) Definition (1) Assisted reproductive technology; ART The term assisted reproductive technology or ART means any treatment or procedure that includes the handling of human eggs or embryos to help achieve a pregnancy, including in vitro fertilization, egg or embryo cryopreservation, and egg or embryo donation. Such term includes any medication related to such a treatment or procedure. (2) Intrauterine insemination; IUI The term intrauterine insemination or IUI means a procedure that places sperm directly into an individual’s uterus at the time of the individual’s ovulation to increase the chances of fertilization. Such term includes any medication associated with such a procedure. (c) Required coverage A group health plan shall provide coverage for ART and IUI determined appropriate by the health care provider, regardless of whether the participant or beneficiary receiving ART or IUI has been diagnosed with infertility as defined by the American Society for Reproductive Medicine, if the ART or IUI is performed at, or prescribed by, a licensed medical facility. (d) Limitation Cost-sharing, including deductibles and coinsurance, or other limitations for ART or IUI may not be imposed with respect to ART or IUI required to be covered under subsection (c) to the extent that such cost-sharing exceeds the cost-sharing applied to other medical services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such medical services, except where such limitation is more favorable with respect to ART or IUI. The Secretary shall promulgate interim final regulations to carry out this subsection, notwithstanding the notice and comment requirements of section 553 of title 5, United States Code. (e) Prohibitions A group health plan may not— (1) provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to seek or obtain ART or IUI to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide medically appropriate ART or IUI to participants or beneficiaries; (2) prohibit a provider from discussing with a participant or beneficiary ART or IUI relating to this section; (3) penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided ART or IUI to a qualified participant or beneficiary in accordance with this section; or (4) on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. 18116), exclude any individual from coverage in accordance with this section, or discriminate against any individual with respect to such coverage. (f) Rule of construction Nothing in this section shall be construed to require a participant or beneficiary to undergo ART or IUI. (g) Notice A group health plan shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the Secretary. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted— (1) not later than the earlier of— (A) in the first standard mailing made by the plan to the participant or beneficiary following the effective date of such regulations; (B) as part of any yearly informational packet sent to the participant or beneficiary; or (C) January 1, 2027; (2) in the case of a participant or beneficiary not enrolled in the plan on the date of transmission under paragraph (1), upon initial enrollment of such participant or beneficiary; and (3) on an annual basis after the transmission under paragraph (1) or (2). (h) Level and type of reimbursements Nothing in this section shall be construed to prevent a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.. (B) Clerical amendment The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9827. Standards relating to benefits for assisted reproductive technology and intrauterine insemination.. (b) Conforming amendments (1) PHSA Section 2724(c) of the Public Health Service Act (42 U.S.C. 300gg–23(c)) is amended by striking section 2704 and inserting sections 2704 and 2799A–12. (2) ERISA Section 731(c) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191(c)) is amended by striking section 711 and inserting sections 711 and 727. (c) Effective dates (1) In general The amendments made by subsections (a) and (b) shall apply for plan years beginning on or after the date that is 6 months after the date of enactment of this Act. (2) Collective bargaining exception (A) In general In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of enactment of this Act, the amendments made by subsection (a) shall not apply to plan years beginning before the later of— (i) the date on which the last collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of enactment of this Act), or (ii) the date occurring 6 months after the date of the enactment of this Act. (B) Clarification For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by subsection (a) shall not be treated as a termination of such collective bargaining agreement.