[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3480 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 3480
To amend the Patient Protection and Affordable Care Act to include
fertility treatment and care as an essential health benefit.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 19, 2025
Ms. Underwood introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Patient Protection and Affordable Care Act to include
fertility treatment and care as an essential health benefit.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Coverage for Inclusive and
Valued Families Act of 2025'' or the ``Health Coverage for IVF Act of
2025''.
SEC. 2. INCLUDING FERTILITY TREATMENT AND CARE AS AN ESSENTIAL HEALTH
BENEFIT.
(a) In General.--Section 1302(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(b)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
striking ``paragraph (2)'' and inserting ``paragraphs
(2) and (6)''; and
(B) by adding at the end the following new
subparagraph:
``(K) Fertility treatment and care.''; and
(2) by adding at the end the following new paragraph:
``(6) Fertility treatment and care defined.--For purposes
of paragraph (1)(K), the term `fertility treatment and care'
means the following medically appropriate items and services
furnished to an individual:
``(A) Preservation of human oocytes, sperm, or
embryos for later reproductive use.
``(B) Artificial insemination, including
intravaginal insemination, intracervical insemination,
and intrauterine insemination.
``(C) Assisted reproductive technology, including
in vitro fertilization and other treatments or
procedures in which reproductive genetic material, such
as oocytes, sperm, fertilized eggs, and embryos, are
handled, when clinically appropriate, and including at
least 3 complete oocyte retrievals and an unlimited
number of embryo transfers from such retrievals
(regardless of whether such retrieval was performed on,
before, or after the date of the enactment of this
paragraph) in accordance with the guidelines of the
American Society for Reproductive Medicine and using
single embryo transfer when recommended and medically
appropriate.
``(D) Genetic testing of embryos.
``(E) Medications prescribed, as indicated for
fertility.
``(F) Gamete donation.
``(G) Such other information, referrals,
treatments, procedures, medications, laboratory
testing, technologies, and services relating to
fertility as the Secretary determines appropriate.''.
(b) Additional Requirements.--Subpart II of part A of title XXVII
of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is
amended by adding at the end the following new section:
``SEC. 2730. REQUIREMENTS RELATING TO FERTILITY TREATMENT AND CARE.
``(a) In General.--In the case of health insurance coverage offered
in the individual or small group market that provides both medical and
surgical benefits and benefits for fertility treatment and care (as
defined in section 1302(b) of the Patient Protection and Affordable
Care Act), such coverage shall ensure that--
``(1) the financial requirements applicable to such
fertility treatment and care benefits are no more restrictive
than the predominant financial requirements applied to
substantially all medical and surgical benefits covered by the
coverage, and there are no separate cost sharing requirements
that are applicable only with respect to fertility treatment
and care benefits; and
``(2) the treatment limitations applicable to such
fertility treatment and care benefits are no more restrictive
than the predominant treatment limitations applied to
substantially all medical and surgical benefits covered by the
coverage and there are no separate treatment limitations that
are applicable only with respect to fertility treatment and
care benefits.
``(b) Prohibition on Denial of Care.--A health insurance issuer
offering health insurance coverage in the individual or small group
market may not deny benefits for fertility treatment and care for
individual on the basis that such individual lacks a diagnosis of
infertility.
``(c) Utilization Management Tools.--
``(1) In general.--A health insurance issuer offering
health insurance coverage in the individual or small group
market that imposes any utilization management tool with
respect to fertility treatment and care shall, for each of the
first 5 plan years beginning on or after the date that is 1
year after the date of the enactment of this Act (and, upon
request of the Secretary or the Comptroller General of the
United States, for any subsequent plan year), conduct an
analysis of the application of any such tool to such treatment
and care and submit such analysis to the Secretary and to the
Comptroller General of the United States. Such analysis shall
contain the following information:
``(A) The specific coverage terms or other relevant
terms regarding the application of such tools to such
benefits and a description of all such benefits.
``(B) The factors used to determine when
utilization management tools apply to such benefits.
``(C) The evidentiary standards used in designing
the application of such tools with respect to such
benefits and any other source or evidence used to
determine the application of such tools to such
benefits.
``(D) Information demonstrating how application of
such tools to such benefits are consistent with
clinical guidelines for fertility treatment and care.
``(E) Any findings by the issuer that such coverage
is not in compliance with this section.
``(2) Report.--For plan years beginning on or after the
date that is 1 year after the date of the enactment of this
section, the Comptroller General of the United States shall
submit to Congress and make publicly available a report that
contains the following:
``(A) A summary of the analyses submitted under
paragraph (1) with respect to such plan year.
``(B) An identification of each health insurance
issuer that failed to submit an analysis under
paragraph (1).
``(C) With respect to each health insurance issuer
that did submit such an analysis, a specification as to
whether such issuer submitted information sufficient to
determine whether such issuer was in compliance with
such requirements.
``(D) For each health insurance issuer that did
submit information sufficient to determine such
compliance, a finding of whether such issuer was in
compliance with such requirements.
``(d) Definitions.--The terms `financial requirement',
`predominant', and `treatment limitation' have the meaning given such
terms in section 2726(a)(3).''.
(c) Effective Date.--The amendments made by this section shall
apply to plan years beginning on or after the date that is 1 year after
the date of the enactment of this Act.
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