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SPONSOR: |
Park
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DATE TYPED: |
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HB |
45 |
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SHORT TITLE: |
Insurance Coverage for Infertility |
SB |
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ANALYST: |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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See
Narrative |
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Responses
Received From
Commission
on the Status of Women (CSW)
Public
Regulation Commission (PRC)
Human
Services Department (HSD)
Retiree
Health Care Authority (RHCA)
Public
School Insurance Authority (PSIA)
General
Services Department (GSD)
SUMMARY
Synopsis
of Bill
House Bill 45 requires
individual or group health insurance policies, health care plans or certificates
of health insurance that are delivered or issued for delivery in
HB 45 also mandates
health insurance contracts to include coverage for childhood immunizations,
minimum hospital stays for mastectomies and lymph node dissections,
prescription contraceptive drugs or devices approved the food and drug
administration and infertility diagnosis and treatment.
Significant
Issues
The insurance industry generally opposes
mandated coverages such as those contained in HB 45. They argue that the
decision as to which benefits will be covered should be between the purchaser
of health insurance and the company selling the coverage. Unfortunately for an employee in a group, it
is the employer who is making the decision and not the covered individuals.
There is also a distinction between coverage for
a medical condition versus coverage for infertility diagnosis and
treatment. Health insurers generally
cover the diagnosis and treatment of natural physical conditions causing
infertility, except for the reversal of sterilization. For instance, where an enrollee’s primary
care physician in consultation with a health care plan determines that a
service such as a Fallopian tube obstruction or a hormone deficiency (as
opposed to hormonal manipulations or excess hormones to increase product of
mature ova for fertilization) is medically necessary, then these services would
be covered. Likewise, health insurers
provide coverage for infertility testing to diagnose the cause of
infertility. However, health insurance
products currently may exclude coverage for certain services related to
infertility diagnosis and treatment such as sperm donor harvesting,
in-vitro fertilization, Famete Intrafallopian Transfer (GIFT), Zygote
Intrafallopian Transfer ( ZIFT), or the reversal of voluntary sterilization.
FISCAL IMPLICATIONS
Many of the procedures related to infertility diagnosis
and treatment are extremely expensive. In-vitro fertilization, for example
costs more than $10,000 a procedure and a woman can undergo several
unsuccessful procedures a year. Insurance premiums will certainly rise, but the
industry is unable to quantify the amount.
The
State of
ADMINISTRATIVE IMPLICATIONS
House Bill 45 requires the form filing unit
of the PRC’s Insurance Division’s Life & Health Bureau to review and
process amended filings by insurers requiring such coverage. Likewise, the Life
& Health Bureau would have to ensure that the industry was aware of this
new mandated benefit and ensure compliance therewith. Since the PRC is
currently handling form filing and notification to the industry they can handle
the provisions of HB 45 with existing staff.
POSSIBLE
QUESTIONS
Should the State mandate extremely expensive
infertility coverage which will benefit a very small number of individuals and
force every other insured person to pay
higher premiums?
DW/yr