[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4648 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4648
To require health insurance plans to provide coverage for fertility
treatment, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2025
Ms. DeLauro (for herself, Mr. Doggett, Ms. Schakowsky, and Mrs.
Foushee) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and Workforce, Oversight and Government
Reform, Armed Services, and Veterans' Affairs, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To require health insurance plans to provide coverage for fertility
treatment, and for other purposes.
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 ``Access to Fertility Treatment and
Care Act''.
SEC. 2. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
(a) In General.--
(1) PHSA.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following:
``SEC. 2799A-11. STANDARDS RELATING TO BENEFITS FOR FERTILITY
TREATMENT.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall provide
coverage for fertility treatment, if such plan or coverage provides
coverage for obstetrical services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary determines
appropriate.
``(c) Required Coverage.--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 fertility treatment determined appropriate by the health care
provider, regardless of whether the participant, beneficiary, or
enrollee receiving such treatment has been diagnosed with infertility
as defined by the American Society for Reproductive Medicine, if the
treatment is performed at, or prescribed by, a medical facility that is
in compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(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, beneficiary, or enrollee to encourage such
participant, beneficiary, or enrollee not to seek or obtain
fertility treatment to which such participant, beneficiary, or
enrollee is entitled under this section or to providers to
induce such providers not to provide medically appropriate
fertility treatments to participants, beneficiaries, or
enrollees;
``(2) prohibit a provider from discussing with a
participant, beneficiary, or enrollee fertility treatment
relating to this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant, beneficiary, or
enrollee in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964, title IX of the Education Amendments of
1972, the Age Discrimination Act of 1975, section 504 of the
Rehabilitation Act of 1973, or section 1557 of the Patient
Protection and Affordable Care Act, exclude any individual from
coverage in accordance with this section, or discriminate
against any individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant, beneficiary, or enrollee to undergo
fertility treatment.
``(g) Notice.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall provide
notice to each participant, beneficiary, and enrollee under such plan
or coverage 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) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant, beneficiary, or
enrollee following the effective date of such
regulations;
``(B) as part of any yearly informational packet
sent to the participant, beneficiary, or enrollee; or
``(C) January 1, 2027;
``(2) in the case of a participant, beneficiary, or
enrollee not enrolled in the plan or coverage on the date of
transmission under paragraph (1), upon initial enrollment of
such participant, beneficiary, or enrollee; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(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.''.
(2) ERISA.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following:
``SEC. 726. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage shall provide coverage for
fertility treatment, if such plan or coverage provides coverage for
obstetrical services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary of Health and
Human Services determines appropriate.
``(c) Required Coverage.--A group health plan and a health
insurance issuer offering group health insurance coverage that includes
coverage for obstetrical services shall provide coverage for fertility
treatment determined appropriate by the health care provider,
regardless of whether the participant or beneficiary receiving such
treatment has been diagnosed with infertility as defined by the
American Society for Reproductive Medicine, if the treatment is
performed at, or prescribed by, a medical facility that is in
compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain fertility treatment to which
such participant or beneficiary is entitled under this section
or to providers to induce such providers not to provide
medically appropriate fertility treatments to participants or
beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary fertility treatment relating to this
section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant or beneficiary
in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo fertility
treatment.
``(g) Notice.--A group health plan and a health insurance issuer
offering group health insurance coverage shall provide notice to each
participant and beneficiary under such plan or coverage 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) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant or beneficiary
following the effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan or coverage on the date of transmission
under paragraph (1), upon initial enrollment of such
participant or beneficiary; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(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 health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 et seq.) is amended by
inserting after the item relating to section 725 the
following new item:
``Sec. 726. Standards relating to benefits for fertility treatment.''.
(3) IRC.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``SEC. 9826. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
``(a) In General.--A group health plan shall provide coverage for
fertility treatment, if such plan provides coverage for obstetrical
services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary of Health and
Human Services determines appropriate.
``(c) Required Coverage.--A group health plan that includes
coverage for obstetrical services shall provide coverage for fertility
treatment determined appropriate by the health care provider,
regardless of whether the participant or beneficiary receiving such
treatment has been diagnosed with infertility as defined by the
American Society for Reproductive Medicine, if the treatment is
performed at, or prescribed by, a medical facility that is in
compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment 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 other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain fertility treatment to which
such participant or beneficiary is entitled under this section
or to providers to induce such providers not to provide
medically appropriate fertility treatments to participants or
beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary fertility treatment relating to this
section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant or beneficiary
in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo fertility
treatment.
``(g) Notice.--A group health plan 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 and shall be transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan to the participant or beneficiary following the
effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan on the date of transmission under
paragraph (1), upon initial enrollment of such participant or
beneficiary; and
``(3) on an annual basis after the transmission under