Improve Access to Infertility Treatment and Care in FL
Improve Access to Infertility Treatment and Care in FL
Like ALL other diseases, infertility and its treatments should be covered by health insurance. The ability to have a family should NOT be denied to anyone on account of a lack of insurance coverage for MEDICALLY NECESSARY treatment. The State of Florida does not require insurance companies to offer fertility coverage.
WOMEN, MEN & NON-BINARY FLORIDIANS & AMERICANS, let’s empower ourselves to bring tiny footsteps, love and laughter into our homes. Petition our representatives & senators to bring our fertility fight to the forefront, by re-introducing and proposing mandated fertility coverage at the state AND federal level.
May our efforts be fruitful. And may your reproductive odds be ever in your favor!
Information following information was adapted from: H.R.2803 - Access to Infertility Treatment and Care Act116th Congress (2019-2020)
(1) Infertility is a medical disease recognized by the World Health Organization, the American Society for Reproductive Medicine, and the American Medical Association that affects men and women equally.
(2) According to the Centers for Disease Control and Prevention, 1 in 8 couples have difficulty getting pregnant or sustaining a pregnancy.
(3) Infertility affects a broad spectrum of prospective parents. No matter what race, religion, sexual orientation, or economic status one is, infertility does not discriminate.
(4) According to the Centers for Disease Control and Prevention, 11 percent of women in the United States between the ages of 15 and 44 have difficulty getting pregnant or staying pregnant. Similarly, 9 percent of men in the United States between the ages of 15 and 44 experience infertility.
(6) Leading causes of infertility include chronic conditions and diseases of the endocrine or metabolic systems, such as primary ovarian insufficiency, polycystic ovarian syndrome, endometriosis, thyroid disorders, menstrual cycle defects, autoimmune disorders, hormonal imbalances, testicular disorders, and urological health issues. Other causes include structural problems or blockages within the reproductive system, exposure to infectious diseases, occupational or environmental hazards, or genetic influences.
(7) Recent improvements in therapy and cryopreservation make pregnancy possible for more people than in past years.
8) A 2017 national survey of employer-sponsored health plans found that 44 percent of employers with at least 500 employees did not cover infertility services, and 25 percent of companies with 20,000 or more employees did not cover infertility services.
9) Infertility coverage can not be purchased in the health insurance marketplace; it can only be obtained in FL through group plan coverage IF it happens to be offered by an employer.
(10) Coverage for infertility services under State Medicaid programs is limited. The Medicaid programs of only 5 States provide diagnostic testing for women and men in all of their program eligibility pathways; the Medicaid program of only one State provides coverage for certain medications for women experiencing infertility; and no State Medicaid programs cover intrauterine insemination or in vitro fertilization.
(11) States that do not require private insurance coverage of assisted reproductive technology have higher rates of multiple births.
STANDARDS RELATING TO BENEFITS FOR TREATMENT OF INFERTILITY AND PREVENTION OF IATROGENIC INFERTILITY.
“(a) In General.—A group health plan or a health insurance issuer offering group or individual health insurance coverage shall ensure that such plan or coverage provides coverage for—
“(1) the treatment of infertility, including nonexperimental assisted reproductive technology procedures, if such plan or coverage provides coverage for obstetrical services; and
“(2) standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
“(b) Definitions.—In this section:
“(1) the term ‘assisted reproductive technology’ means treatments or procedures that involve the handling of human egg, sperm, and embryo outside of the body with the intent of facilitating a pregnancy, including in vitro fertilization, egg, embryo, or sperm cryopreservation, egg or embryo donation, and gestational surrogacy;
“(2) the term ‘infertility’ means a disease, characterized by the failure to establish a clinical pregnancy—
“(A) after 12 months of regular, unprotected sexual intercourse; or
“(B) due to a person's incapacity for reproduction either as an individual or with his or her partner, which may be determined after a period of less than 12 months of regular, unprotected sexual intercourse, or based on medical, sexual and reproductive history, age, physical findings, or diagnostic testing; and
“(3) the term ‘iatrogenic infertility’ means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
“(c) Required Coverage.—
“(1) COVERAGE FOR INFERTILITY.—Subject to paragraph (3), a group health plan and a health insurance issuer offering group or individual health insurance coverage that includes coverage for obstetrical services shall provide coverage for treatment of infertility determined appropriate by the treating physician, including, as appropriate, ovulation induction, egg retrieval, sperm retrieval, artificial insemination, in vitro fertilization, genetic screening, intracytoplasmic sperm injection, and any other non-experimental treatment, as determined by the Secretary in consultation with appropriate professional and patient organizations such as the American Society for Reproductive Medicine, RESOLVE: The National Infertility Association, and the American College of Obstetricians and Gynecologists.
“(2) COVERAGE FOR IATROGENIC INFERTILITY.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage of fertility preservation services for individuals who undergo medically necessary treatment that may cause iatrogenic infertility, as determined by the treating physician, including cryopreservation of gametes and other procedures, as determined by the Secretary, consistent with established medical practices and professional guidelines published by professional medical organizations, including the American Society of Clinical Oncology and the American Society for Reproductive Medicine.
“(3) LIMITATION ON COVERAGE OF ASSISTED REPRODUCTIVE TECHNOLOGY.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for assisted reproductive technology as required under paragraph (1) if—
“(A) the individual is unable to bring a pregnancy to a live birth through minimally invasive infertility treatments, as determined appropriate by the treating physician, with consideration given to participant's or beneficiary's specific diagnoses or condition for which coverage is available under the plan or coverage; and
“(B) the treatment is performed at a medical facility that—
“(i) conforms to the standards of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology; and
“(ii) is in compliance with any standards set by an appropriate Federal agency.
“(d) Limitation.—Cost-sharing, including deductibles and coinsurance, or other limitations for infertility and services to prevent iatrogenic infertility may not be imposed with respect to the services required to be covered under subsection (c) to the extent that such cost-sharing exceeds the cost-sharing applied to similar services under the group health plan or health insurance coverage or such other limitations are different from limitations imposed with respect to such similar services.
“(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 or beneficiary to encourage such participant or beneficiary not to be provided infertility treatments or fertility preservation services to which such participant or beneficiary is entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries;
“(2) prohibit a provider from discussing with a participant or beneficiary infertility treatments or fertility preservation technology or medical treatment options relating to this section; or
“(3) penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility treatments or fertility preservation services to a qualified participant or beneficiary in accordance with this section.
“(f) Rule Of Construction.—Nothing in this section shall be construed to require a participant or beneficiary to undergo infertility treatments or fertility preservation services.
“(g) Notice.—A group health plan and a health insurance issuer offering group or individual health insurance coverage 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 or issuer and shall be transmitted—
“(1) in the next mailing made by the plan or issuer to the participant or beneficiary;
“(2) as part of any yearly informational packet sent to the participant or beneficiary; or
“(3) not later than January 1, 2022,
whichever is earlier.“(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.”.
(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 1 or more collective bargaining agreements between employee representatives and 1 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.
Information adapted from:
H.R.2803 - Access to Infertility Treatment and Care Act116th Congress (2019-2020)
Each fertility-assisted birth is another first step for baby & another leap for humankind. <3