H-1501.1
SECOND SUBSTITUTE HOUSE BILL 1151
State of Washington 68th Legislature 2023 Regular Session
By House Appropriations (originally sponsored by Representatives
Stonier, Macri, Reed, Peterson, Berry, Ramel, Fitzgibbon, Cortes,
Callan, Simmons, Reeves, Lekanoff, Bergquist, Fosse, and Ormsby)
READ FIRST TIME 02/24/23.
1 AN ACT Relating to mandating health plans to provide coverage for
2 the diagnosis of infertility, treatment for infertility, and standard
3 fertility preservation services; adding a new section to chapter
4 48.43 RCW; adding a new section to chapter 41.05 RCW; and creating
5 new sections.
6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
7 NEW SECTION. Sec. 1. (1) The legislature finds that:
8 (a) According to the federal centers for disease control and
9 prevention, over 12 percent of women of reproductive age in the
10 United States have difficulty becoming pregnant or staying pregnant;
11 (b) Infertility is evenly divided between men and women and
12 approximately one-third of cases involve both partners being
13 diagnosed or are unexplained;
14 (c) Increasing accessibility for infertility treatment will
15 expand the state's health services and improve the short and long-
16 term health outcomes for the resulting children and mothers, which
17 may also reduce health care costs by reducing adverse outcomes; and
18 (d) Insurance coverage reduces disparities in access to care for
19 racial and ethnic minorities as well as for LGBTQ persons.
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1 (2) The legislature, therefore, intends to provide coverage for
2 the diagnosis of and treatment for infertility, as well as for
3 standard fertility preservation services.
4 NEW SECTION. Sec. 2. A new section is added to chapter 48.43
5 RCW to read as follows:
6 (1) Group health plans other than small group health plans issued
7 or renewed on or after January 1, 2025, must include coverage for
8 standard fertility preservation services. For persons who underwent
9 standard fertility preservation services, coverage must include two
10 completed oocyte retrievals with unlimited embryo transfers in
11 accordance with the guidelines of the American society for
12 reproductive medicine, using single embryo transfer when recommended
13 and medically appropriate.
14 (2) Group health plans other than small group health plans issued
15 or renewed on or after January 1, 2026, must include coverage for the
16 diagnosis of and treatment for infertility. Coverage must provide for
17 two completed oocyte retrievals with unlimited embryo transfers in
18 accordance with the guidelines of the American society for
19 reproductive medicine, using single embryo transfer when recommended
20 and medically appropriate.
21 (3) The benefits must be provided to enrollees, including covered
22 spouses and covered nonspouse dependents, to the same extent as other
23 pregnancy-related benefits.
24 (4) Group health plans other than small group health plans, may
25 not include:
26 (a) Any exclusions, limitations, or other restrictions on
27 coverage of fertility medications that are different from those
28 imposed on other prescription medications;
29 (b) Any exclusions, limitations, or other restrictions on
30 coverage of any fertility services based on a covered individual's
31 participation in fertility services provided by or to a third party;
32 or
33 (c) Any deductibles, copayments, coinsurance, benefit maximums,
34 waiting periods, or any other limitations on coverage for the
35 diagnosis of infertility, treatment of infertility, and standard
36 fertility preservation services, except as provided in this section,
37 that are different from those imposed upon benefits for services not
38 related to infertility.
39 (5) For the purposes of this section:
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 1 (a) "Diagnosis of and treatment for infertility" means the
2 recommended procedures and medications from the direction of a
3 licensed physician or osteopathic physician that are consistent with
4 established, published, or approved medical practices or professional
5 guidelines from the American college of obstetricians and
6 gynecologists or the American society for reproductive medicine.
7 (b) "Infertility" means a disease, condition, or status
8 characterized by:
9 (i) The failure to establish a pregnancy or to carry a pregnancy
10 to live birth after regular, unprotected sexual intercourse;
11 (ii) A person's inability to reproduce either as a single
12 individual or with the person's partner without medical intervention;
13 (iii) A licensed physician's or osteopathic physician's findings
14 based on a patient's medical, sexual, and reproductive history, age,
15 physical findings, or diagnostic testing; or
16 (iv) Disability as an impairment of function.
17 (c) "Regular, unprotected sexual intercourse" means no more than
18 12 months of unprotected sexual intercourse for a woman under the age
19 of 35 or no more than six months of unprotected sexual intercourse
20 for a woman 35 years of age or older. Pregnancy resulting in
21 miscarriage does not restart the 12-month or six-month time period to
22 qualify as having infertility.
23 (d) "Standard fertility preservation services" means procedures
24 that are consistent with the established medical practices or
25 professional guidelines published by the American society of
26 reproductive medicine or the American society of clinical oncology
27 for a person who has a medical condition or is expected to undergo
28 medication therapy, surgery, radiation, chemotherapy, or other
29 medical treatment that is recognized by medical professionals to
30 cause a risk of impairment to fertility.
31 NEW SECTION. Sec. 3. A new section is added to chapter 41.05
32 RCW to read as follows:
33 (1) Health plans offered to employees and their covered
34 dependents under this chapter issued or renewed on or after January
35 1, 2025, must include coverage for standard fertility preservation
36 services. For persons who underwent standard fertility preservation
37 services, coverage must include two completed oocyte retrievals with
38 unlimited embryo transfers in accordance with the guidelines of the
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 1 American society for reproductive medicine, using single embryo
2 transfer when recommended and medically appropriate.
3 (2) Health plans offered to employees and their covered
4 dependents under this chapter issued or renewed on or after January
5 1, 2026, must include coverage for the diagnosis of and treatment for
6 infertility. Coverage must provide for two completed oocyte
7 retrievals with unlimited embryo transfers in accordance with the
8 guidelines of the American society for reproductive medicine, using
9 single embryo transfer when recommended and medically appropriate.
10 (3) The benefits must be provided to enrollees, including covered
11 spouses and covered nonspouse dependents, to the same extent as other
12 pregnancy-related benefits.
13 (4) Health plans offered to employees and their covered
14 dependents under this chapter, may not include:
15 (a) Any exclusions, limitations, or other restrictions on
16 coverage of fertility medications that are different from those
17 imposed on other prescription medications;
18 (b) Any exclusions, limitations, or other restrictions on
19 coverage of any fertility services based on a covered individual's
20 participation in fertility services provided by or to a third party;
21 or
22 (c) Any deductibles, copayments, coinsurance, benefit maximums,
23 waiting periods, or any other limitations on coverage for the
24 diagnosis of infertility, treatment of infertility, and standard
25 fertility preservation services, except as provided in this section,
26 that are different from those imposed upon benefits for services not
27 related to infertility.
28 (5) For the purposes of this section:
29 (a) "Diagnosis of and treatment for infertility" means the
30 recommended procedures and medications from the direction of a
31 licensed physician or osteopathic physician that are consistent with
32 established, published, or approved medical practices or professional
33 guidelines from the American college of obstetricians and
34 gynecologists or the American society for reproductive medicine.
35 (b) "Infertility" means a disease, condition, or status
36 characterized by:
37 (i) The failure to establish a pregnancy or to carry a pregnancy
38 to live birth after regular, unprotected sexual intercourse;
39 (ii) A person's inability to reproduce either as a single
40 individual or with the person's partner without medical intervention;
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 1 (iii) A licensed physician's or osteopathic physician's findings
2 based on a patient's medical, sexual, and reproductive history, age,
3 physical findings, or diagnostic testing; or
4 (iv) Disability as an impairment of function.
5 (c) "Regular, unprotected sexual intercourse" means no more than
6 12 months of unprotected sexual intercourse for a woman under the age
7 of 35 or no more than six months of unprotected sexual intercourse
8 for a woman 35 years of age or older. Pregnancy resulting in
9 miscarriage does not restart the 12-month or six-month time period to
10 qualify as having infertility.
11 (d) "Standard fertility preservation services" means procedures
12 that are consistent with the established medical practices or
13 professional guidelines published by the American society of
14 reproductive medicine or the American society of clinical oncology
15 for a person who has a medical condition or is expected to undergo
16 medication therapy, surgery, radiation, chemotherapy, or other
17 medical treatment that is recognized by medical professionals to
18 cause a risk of impairment to fertility.
19 NEW SECTION. Sec. 4. This act may be known and cited as the
20 Washington state building families act.
21 NEW SECTION. Sec. 5. The insurance commissioner may adopt rules
22 to implement, administer, and enforce section 2 of this act.
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