§ 38a-536 — Mandatory coverage for infertility diagnosis and treatment. Limitations.

Connecticut § 38a-536

• Jurisdiction: Connecticut
• Title 38a: Insurance
• Ch. 700c: Health Insurance

Text

(a) Subject to the limitations set forth in subsection (b) of this section and except as provided in subsection (c) of this section, each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2018, shall provide coverage for the medically necessary expenses for the diagnosis and treatment of infertility, including, but not limited to, ovulation induction, intrauterine insemination, in-vitro fertilization, uterine embryo lavage, embryo transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer. For purposes of this section, “infertility” means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. (b) Such policy may: (1) Limit such coverage for ovulation induction to a lifetime maximum benefit of four cycles; (2) Limit such coverage for intrauterine insemination to a lifetime maximum benefit of three cycles; (3) Limit such coverage for lifetime benefits to a maximum of two cycles, with not more than two embryo implantations per cycle, for in-vitro fertilization, gamete intra-fallopian transfer, zygote intra-fallopian transfer or low tubal ovum transfer, provided each such fertilization or transfer shall be credited toward such maximum as one cycle; (4) Limit coverage for in-vitro fertilization, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer to those individuals who have been unable to conceive or produce conception or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures covered under such policy. Nothing in this subdivision shall be construed to deny the coverage required by this section to any individual who foregoes a particular infertility treatment or procedure if the individual's physician determines that such treatment or procedure is likely to be unsuccessful; and (5) Require that covered infertility treatment or procedures be performed at facilities that conform to the standards and guidelines developed by the American Society of Reproductive Medicine or the Society of Reproductive Endocrinology and Infertility. (c) (1) Any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer a group health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets. (2) Upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods. (d) Any health insurance policy issued pursuant to subsection (c) of this section shall provide written notice to each insured or prospective insured that methods of diagnosis and treatment of infertility are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy. (e) As used in this section, “religious employer” means an employer that is a “qualified church-controlled organization”, as defined in 26 USC 3121 or a church-affiliated organization. (f) Except as provided in subsections (c) to (e), inclusive, of this section, no group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2024, may make any distinction or discrimination between persons on the basis of gender identity or expression, sexual orientation or age with respect to health insurance coverage for the medically necessary expenses for the diagnosis and treatment of infertility, except that such policy may consider age as a factor on the basis of a determination of medical necessity, using professional guidelines published by the American Society for Reproductive Medicine, its successor organization or a comparable organization. For purposes of this subsection, “gender identity or expression” has the same meaning as provided in section 1-1n . See Sec. 38a-509 for similar provisions re individual policies.

Legislative History

(P.A. 89-120; P.A. 05-196, S. 2; P.A. 15-118, S. 18; P.A. 17-55, S. 2; P.A. 23-127, S. 12.) History: P.A. 05-196 replaced former provisions with Subsecs. (a) to (e) re required coverage for diagnosis and treatment of infertility, limitations and religious and moral belief exclusions; P.A. 15-118 made technical changes in Subsec. (c); P.A. 17-55 amended Subsec. (a) by replacing “October 1, 2005,” with “January 1, 2018,” replacing “a presumably healthy individual” with “an individual”, and adding “or such treatment is medically necessary”, effective January 1, 2018; P.A. 23-127 amended Subsec. (b) by deleting former Subdiv. (1) re coverage limited until such individual's fortieth birthday, redesignating existing Subdivs. (2) to (6) as Subdivs. (1) to (5), deleting former Subdiv. (7) re coverage limited to individuals who maintained coverage under such policy for 12 months, deleting former Subdiv. (8) re required disclosure to individual's health carrier of previous infertility treatment or procedures under different policy, added Subsec. (f) re prohibiting discrimination or distinction on basis of gender identity or expression, sexual orientation or age with respect to coverage for infertility diagnosis and treatment, except that age may be considered a factor on basis of a determination of medical necessity and made technical and conforming changes in Subsecs. (a) and (b).