Enrolled Copy S.B. 35
1 INFERTILITY TREATMENT COVERAGE AMENDMENTS
2024 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Luz Escamilla House Sponsor: Rex P. Shipp
2
3 LONG TITLE
4 General Description:
5 This bill modifies provisions related to the expanded infertility treatment coverage health
6 benefit.
7 Highlighted Provisions:
8 This bill:
9 ▸ eliminates the scheduled repeal of the expanded infertility treatment coverage pilot
10 program;
11 ▸ makes permanent the benefit for assisted reproductive technology for individuals within
12 the state health insurance risk pool; and
13 ▸ makes technical and conforming changes.
14 Money Appropriated in this Bill:
15 None
16 Other Special Clauses:
17 This bill provides a special effective date.
18 Utah Code Sections Affected:
19 AMENDS:
20 49-20-418, as last amended by Laws of Utah 2021, Chapters 64, 195
21 63I-1-249, as last amended by Laws of Utah 2021, Chapter 195
22
23 Be it enacted by the Legislature of the state of Utah:
24 Section 1. Section 49-20-418 is amended to read:
25 49-20-418 . Expanded infertility treatment benefit.
26 (1) As used in this section:
27 (a) "Assisted reproductive technology" means the same as the term is defined in 42
28 U.S.C. Sec. 263a-7.
S.B. 35 Enrolled Copy
29 (b) "Physician" means the same as the term is defined in Section 58-67-102.
30 [(c) "Pilot program" means the expanded infertility treatment coverage pilot program
31 described in Subsection (2).]
32 [(d)] (c) "Qualified assisted reproductive technology cycle" means the use of assisted
33 reproductive technology to transfer a single embryo for implantation.
34 [(e)] (d) "Qualified individual" means [a covered] an individual [who is ] :
35 (i) covered within the state risk pool; and
36 (ii) eligible for maternity benefits under the program.
37 [(2) (a) Beginning plan year 2018-19, and ending plan year 2023-24, the program shall
38 offer a pilot program within the state risk pool that provides coverage to a qualified
39 individual for the use of an assisted reproductive technology.]
40 [(b) (i) For plan year 2018-19, 2019-20, or 2020-21, the pilot program shall offer a
41 one-time benefit of $4,000 toward the costs of using an assisted reproductive technology
42 for each qualified individual.]
43 [(ii)] (2) (a) [For plan year 2021-22, 2022-23, or 2023-24, the pilot] The program shall
44 offer a benefit of $4,000 to a qualified individual toward the costs of each qualified
45 assisted reproductive technology cycle.
46 [(c)] (b) [The benefits described in Subsection (2)(b) are] The benefit is subject to the
47 same cost sharing requirements as the [covered] qualified individual's plan.
48 (3) [Coverage offered under the pilot program applies if:] A qualified individual shall
49 receive the benefit described in Subsection (2) if:
50 (a) the qualified individual is the patient who will use the assisted reproductive
51 technology [is a qualified individual];
52 (b) (i) the patient's physician verifies that the patient or the patient's spouse has a
53 demonstrated condition recognized by a physician as a cause of infertility; or
54 (ii) the patient attests that the patient is unable to conceive a pregnancy or carry a
55 pregnancy to a live birth after a year or more of regular sexual relations without
56 contraception;
57 (c) the patient attests that the patient has been unable to attain a successful pregnancy
58 through any less-costly, potentially effective infertility treatments for which coverage
59 is available under the health benefit plan; and
60 (d) the use of the assisted reproductive technology procedure complies with the
61 program's clinical policies and is performed at a medical facility that conforms to the
62 minimal standards for programs of assisted reproductive technology procedures
-2-
Enrolled Copy S.B. 35
63 adopted by the American Society for Reproductive Medicine.
64 [(4) Coverage offered under the pilot program:]
65 (4) (a) The provision of a benefit in accordance with this section shall satisfy, in
66 accordance with Subsection 31A-22-610.1(1)(c)(ii), the requirement to provide an
67 adoption indemnity benefit to a qualified individual under Section 31A-22-610.1[; ] .
68 (b) [does not apply to a qualified individual if the] If a qualified individual has received
69 the adoption indemnity benefit required under Section 31A-22-610.1[; and] , the
70 qualified individual may not receive a benefit in accordance with this section.
71 [(c) for plan year 2021-22, 2022-23, or 2023-24, shall apply to a qualified individual, even
72 if the qualified individual received the benefit described in Subsection (2)(b)(i).]
73 [(5) (a) The purpose of the pilot program is to study the efficacy of providing coverage for
74 the use of an assisted reproductive technology and is not a mandate for coverage of an
75 assisted reproductive technology within all health plans offered by the program.]
76 [(b) The program shall report to the Retirement and Independent Entities Interim
77 Committee regarding the costs and benefits of the pilot program:]
78 [(i) on or before October 1; and]
79 [(ii) during calendar years 2022 and 2023.]
80 [(6) Under Section 63J-1-603, the Legislature intends that the cost of the pilot program
81 will be paid from money above the minimum recommended level in the public
82 employees' state risk pool reserve.]
83 Section 2. Section 63I-1-249 is amended to read:
84 63I-1-249 . Repeal dates: Title 49.
85 [(1)] Title 49, Chapter 11, Part 13, Phased Retirement, is repealed January 1, 2025.
86 [(2) Section 49-20-418 is repealed January 1, 2025.]
87 Section 3. Effective date.
88 This bill takes effect on July 1, 2024.
-3-
Statutes affected: Introduced: 49-20-418, 63I-1-249
Enrolled: 49-20-418, 63I-1-249