MISSISSIPPI LEGISLATURE
2018 Regular Session
To: Insurance
By: Representatives McGee, Steverson, Touchstone, Aguirre, Bain, Barnett, Bounds, Cockerham, Evans (45th), Massengill, Sanford, White, Sykes, Arnold, Powell, Miles, Crawford, Baria, Dixon
AN ACT TO REQUIRE HEALTH INSURANCE POLICIES THAT PROVIDE PREGNANCY RELATED BENEFITS TO PROVIDE COVERAGE FOR MEDICALLY NECESSARY EXPENSES OF DIAGNOSIS AND TREATMENT OF INFERTILITY; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) Except as otherwise provided in this section, a health insurance policy covering persons residing in Mississippi that provides pregnancy related benefits must provide coverage to the same extent as for pregnancy-related procedures are covered, coverage for medically necessary expenses of diagnosis and treatment of infertility, including, but not limited to, the following: artificial insemination; in vitro fertilization; gamete intrafallopian transfer; sperm, egg and/or inseminated egg procurement and processing; banking of sperm or inseminated eggs, to the extent such costs are not covered by the patient's insurer, if any; intra-cytoplasmic sperm injection; zygote intrafallopian transfer; assisted hatching; and cryopreservation of eggs.
(2) Coverage under this section shall be included in health insurance policies that are delivered, executed, issued, amended, adjusted, or renewed in this state, or outside this state if insuring residents of this state, on or after July 1, 2018. No insurer can terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual because the individual is diagnosed with or has received treatment for infertility.
(3) Coverage of assisted reproductive technology procedures under this section may not exceed a lifetime benefit of Twenty Thousand Dollars ($20,000.00).
(4) The benefits of coverage for infertility treatment shall be subject to the same deductibles, coinsurance and out-of-pocket limitations as under maternity benefit coverage.
(5) Coverage shall be provided to married females and males.
(6) Policies must provide coverage for diagnostic tests and procedures that include, but are not limited to, the following:
(a) Hysterosalpingogram;
(b) Hysteroscopy;
(c) Endometrial biopsy;
(d) Laparoscopy;
(e) Sono-hysterogram;
(f) Postcoital tests;
(g) Testis biopsy;
(h) Semen analysis;
(i) Blood tests; and
(j) Ultrasounds.
Diagnostic and exploratory procedures shall be covered, including surgical procedures to correct the medically diagnosed disease or condition of the reproductive organs, including but not limited to: endometriosis, collapsed/clogged fallopian tubes and testicular failure.
(7) Every policy that provides for prescription drug coverage shall also include drugs (approved by the FDA) for use in the diagnosis and treatment of fertility. Insurers shall not impose any exclusions, limitations or other restrictions on coverage of infertility drugs that are different from those imposed on any other prescription drugs, nor shall they impose deductibles, copayment, coinsurance, benefit maximums, waiting periods or any other limitations on coverage for required infertility benefits that are different from those imposed upon benefits for services not related to infertility.
(8) Nothing in this section shall be construed to limit the number of treatment cycles covered.
(9) Coverage shall include medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person. As used in this section, "iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes. Subsection (5) of this section shall not apply to fertility preservation to avoid iatrogenic infertility.
(10) As used in this section, "infertility" means a disease, defined by the failure to achieve a successful pregnancy after twelve (12) months or more appropriate, timed unprotected intercourse or therapeutic donor insemination. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after six (6) months for women over thirty-five (35) years of age.
(11) As used in this section, "health insurance policy" includes all individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, and individual and group service contracts issued by a health maintenance organization or preferred provider organization.
(12) This section does not apply to self-insured group arrangements, including the State Health Insurance Plan for employees of the State of Mississippi.
(13) Coverage required under this section must be for the policyholder and the spouse of the policyholder if the spouse is a covered person under the policy.
(14) Fertilization covered under this section shall only include fertilization of the covered person's eggs with the spouse's sperm.
(15) Nothing in this section shall apply to nongrandfathered plans in the individual and small group markets that are required to include essential health benefits under the Patient Protection and Affordable Care Act or to Medicare supplement, accident-only, specified disease, hospital indemnity, disability income, long term care, or other limited benefit hospital insurance policies.
SECTION 2. Procedures under Section 1 of this act must conform with the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine guidelines.
SECTION 3. This act shall take effect and be in force from and after July 1, 2018.