RD57 - Mandated Coverage for Infertility - Senate Bill 631 (2008)


Executive Summary:
Senate Bill 631 was referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) for the review by the Senate Committee on Commerce and Labor during the 2008 Session of the General Assembly. Senate Bill 631 was introduced by Senator Patricia Ticer.

Senate Bill 631 adds 38.2-3418.15 to the mandated benefits article and amends §38.2-4319 in the Code of Virginia to make it applicable to Health Maintenance Organizations (HMOs).

The bill requires insurers to provide coverage for treatments for infertility. The bill applies to insurers proposing to issue individual or group accident and sickness policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; corporations providing individual or group subscription contracts; and HMOs providing health care plans to provide coverage for the treatment of infertility.

The bill defines “infertility” as the inability to conceive after one year of unprotected sexual intercourse. Infertility treatment does not include reversal of vasectomy or tubal ligation. “Treatment for infertility” includes, but is not limited to the following procedures performed on a covered individual who is less than 50 years old: in vitro fertilization (IVF), embryo transfer, artificial insemination, gamete intrafallopian tube transfer (GIFT), intracytoplasmic sperm injection, zygote intrafallopian transfer (ZIFT), and low tubal ovum transfer. Treatment must be required only if the covered individual has not undergone four complete oocyte retrievals except that if a live birth follows a complete oocyte retrieval, then two more oocyte retrievals must be covered. “Treatment for infertility” does not include the reversal of a vasectomy or a tubal ligation.

Reimbursement for treatment for infertility must be determined according to the same formula by which charges are developed for other medical and surgical procedures. The coverage must have durational limits, deductibles, and coinsurance factors that are no less favorable than for physical illness generally. The bill applies to policies, contracts or plans delivered, issued for delivery, or extended in the Commonwealth on and after July 1, 2008, or at any time thereafter when any term of the policy, contract or plan is changed or premium adjustments are made. The bill does not apply to short-tem travel, accident only, limited or specified disease, or policies or contracts designed for issuance to persons eligible for Medicare, or similar coverage under state or federal government plans, or short-term nonrenewable policies of no more than six months’ duration.

The Advisory Commission held a public hearing to receive comments on Senate Bill 631 on October 27, 2008 in Richmond, VA. In addition to the bill’s patron, eight speakers addressed the proposal, including the main proponents, RESOLVE: The National Infertility Association (RESOLVE). The Virginia Association of Health Plans (VAHP) opposed the bill. Written comments supporting the bill were received from 17 families and RESOLVE. The VAHP submitted written comments opposing the bill, as well as the Virginia Chamber of Commerce, and the National Federation of Independent Business.

The Advisory Commission voted unanimously (10-0) to recommend against the enactment of Senate Bill 631 on November 19, 2008. The Advisory Commission expressed concern for those Virginia consumers who need infertility treatments and would benefit from the provisions of Senate Bill 631. However, the Advisory Commission members had questions about the cost impact of the bill on individual and group policyholders and the resulting impact on the number of people insured. After reviewing data from other states with mandates for infertility and reviewing other follow-up information, the Advisory Commission voted to not recommend Senate Bill 631.