S-3776

AN ACT Relating to infertility diagnosis and treatment; and adding a new section to chapter 48.43 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 48.43 RCW to read as follows:

(1) The definitions in this subsection apply to this section, unless the context clearly requires otherwise.

(a) "Pregnancy-related benefits" means benefits that cover any medical condition that may be associated with pregnancy, including complications of pregnancy.

(b) "Infertility" means a disease or condition affecting the reproductive system that interferes with the ability of a man or a woman to achieve a pregnancy or of a woman to carry a pregnancy to live birth. The duration of the failure to conceive must be twelve or more months before an investigation is undertaken unless medical history and physical findings dictate earlier evaluation and treatment.

(c) "Nonexperimental procedure" means any clinical treatment or procedure whose safety and efficacy is recognized as such by the American society for reproductive medicine or the American college of obstetricians and gynecologists.

(2) A health plan issued to individuals or groups that provides benefits for pregnancy-related services shall not exclude coverage for the diagnosis or treatment of infertility, including all nonexperimental assisted reproductive technology procedures.

(3) Except as provided in subsection (4) of this section, a health carrier shall not create or impose disincentives for utilization of the benefits required by subsection (2) of this section.

(4) Nothing in this section shall be construed as:

(a) Preventing a health carrier from imposing deductibles, coinsurance, other cost-sharing requirements, or other limitations in relation to providing infertility services, provided that such deductible, coinsurance, other cost-sharing requirement, or other limitation is not greater than or different from the deductible, coinsurance, other cost-sharing requirement, or other limitation for pregnancy-related services covered under the plan;

(b) Requiring a health carrier to cover experimental fertility treatment; or

(c) Requiring coverage for procedures for in vitro fertilization, gamete intrafallopian transfer, or zygote intrafallopian transfer unless:

(i) The covered person has been unable to bring a pregnancy to live birth through less costly, medically appropriate infertility treatments for which coverage is available under the health plan;

(ii) The covered individual has not undergone four completed oocyte retrievals, except that if a live birth followed a completed oocyte retrieval, then two more completed oocyte retrievals shall be covered, with a lifetime cap of six retrievals;

(iii) The procedures are performed at medical facilities that conform to the standards of the American society for reproductive medicine, the society for assisted reproductive technology, or the American college of obstetricians and gynecologists; and

(iv) The laboratory or facility has received accreditation from the college of American pathologists' reproductive laboratory accreditation program.

(5) This section applies to health plans issued or renewed on or after January 1, 2001.

NEW SECTION. Sec. 2. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.