Senate Bill 2655

AN ACT TO REQUIRE HEALTH INSURANCE POLICIES WHICH 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 which provides pregnancy related benefits must provide coverage to the same extent for which pregnancy-related procedures, coverage for medically necessary expenses of diagnosis and treatment of infertility including the following: artificial insemination; in vitro fertilization; sperm, egg and/or inseminated egg procurement and processing and banking of sperm or eggs, to the extent such costs are not covered by the patient's insurer, if any; intra-cytoplasmic sperm injection; assisted hatching and cryopreservation of eggs, sperm or embryo; and fresh and/or subsequent frozen embryo transfers.

(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, 2017. No insurer can terminate coverage, or refuse to deliver, execute, issue, amend, adjust or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for infertility.

(3) Coverage of assisted reproductive technology procedures under this section include coverage of three (3) cycles of intrauterine insemination and three (3) cycles of in vitro fertilization.

(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 diagnostic tests and procedures that include, but are not limited to, the following:

(a) Hysterosalpingogram;

(b) Hysteroscopy;

(d) Laparoscopy;

(e) Laparotomy;

(f) Sono-hysterogram;

(g) Surgical sperm retrieval including testis biopsy;

(h) Semen analysis;

(i) Blood tests/hormonal analysis laboratory 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, disorders affecting the function of the fallopian tubes, testicular failure, uterine anomalies and pelvic adhesive disease.

(7) Every policy that provides for prescription drug coverage shall also include drugs (approved by the FDA in the treatment of infertility) 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 which are different from those imposed upon benefits for services not related to infertility.

(8) 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.

(9) 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, 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.

(10) 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.

(11) This section does not apply to self-insured group arrangements, including the State Health Insurance Plan for employees of the State of Mississippi.

(12) 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.

(13) Fertilization covered under this section shall only include fertilization of the covered person's eggs with the spouse's sperm.

SECTION 2. Procedures under Section 1 of this act must be performed at a facility certified by the College of American Pathologists and/or American Association of Bioanalysis and must conform with the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine guidelines.

SECTION 3. This act shall take effect and be in force from and after July 1, 2017.