The bill amends Sections 27-18-30, 27-19-23, and 27-20-20 of the General Laws to enhance health insurance coverage for infertility treatment. It mandates that any health insurance contract that includes pregnancy-related benefits must cover medically necessary expenses for the diagnosis and treatment of infertility, without discrimination based on age, ancestry, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.

The bill specifies that coverage must include at least four complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval, as well as the medical costs related to an embryo transfer to be made from or on behalf of an insured to a third party. It also ensures coverage regardless of whether donor gametes or embryos are used or if an embryo will be transferred to a surrogate.

Additionally, the bill prohibits insurers from imposing different limitations on infertility treatment compared to other medical services, including deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations. It removes previous age restrictions for coverage, which were limited to women between the ages of 25 and 42, and expands the definition of infertility to include various medical conditions and circumstances recognized by healthcare providers.

Furthermore, the bill ensures that insurers cannot impose pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility, nor can they use any prior diagnosis of or prior treatment of infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits. The definitions and requirements align with established medical guidelines, and clinical guidelines for treatment must be consistent with those from reputable medical organizations such as the American Society for Reproductive Medicine and the American Society of Clinical Oncology.

The provisions of this act are set to take effect on January 1, 2026.

Statutes affected:
5629: 27-18-30, 27-19-23, 27-20-20, 27-41-33