Budget Amendment ID: FY2025-S4-396
EHS 396
Coverage for Fertility Preservation Services
Ms. Creem, Ms. Rausch, Messrs. Feeney, Lewis and Eldridge, Ms. Miranda, Messrs. Gomez, O'Connor, Moore, Payano, Montigny and Keenan and Ms. Edwards moved that the proposed new text be amended by inserting after section ___ the following sections:-
"SECTION ___. Chapter 32A of the General Laws is hereby amended by inserting after section 17S the following section:-
Section 17T. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
'Directly or indirectly cause impairment of fertility', to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
'Standard fertility preservation services', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
(b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.
SECTION ___. Chapter 175 of the General Laws is hereby amended by inserting after section 47UU, inserted by section 56 of chapter 28 of the acts of 2023, the following section:-
Section 47VV. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
'Directly or indirectly cause impairment of fertility', to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
'Standard fertility preservation services', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
(b) The following shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes: (i) any policy of accident and sickness insurance, as described in section 108, that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 that provides hospital expense and surgical expense insurance and that is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder, within or without the commonwealth; and (iii) any employees’ health and welfare fund that provides hospital expense and surgical expense benefits and that is delivered, issued or renewed to any person or group of persons in the commonwealth. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.
SECTION ___. Chapter 176A of the General Laws is hereby amended by inserting after section 8VV, inserted by section 58 of chapter 28 of the acts of 2023, the following section:-
Section 8WW. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
'Directly or indirectly cause impairment of fertility', to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
'Standard fertility preservation services', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
(b) Any contract between a subscriber and a corporation subject to this chapter, pursuant to an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.
SECTION ___. Chapter 176B of the General Laws is hereby amended by inserting after section 4VV, inserted by section 59 of said chapter 28, the following section:-
Section 4WW. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
'Directly or indirectly cause impairment of fertility', to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
'Standard fertility preservation services', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
(b) A subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, the coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.
SECTION ___. Chapter 176G of the General Laws is hereby amended by inserting after section 4NN, inserted by section 60 of said chapter 28, the following section:-
Section 4OO. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:
'Directly or indirectly cause impairment of fertility', to cause circumstances where a disease, or the necessary treatment for a disease, has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
'Standard fertility preservation services', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations.
(b) An individual or group health maintenance contract that is issued, delivered or renewed within the commonwealth shall provide coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures."