§ 49-20-418 — Expanded infertility treatment benefit.

(1) As used in this section:
(1)(a) "Assisted reproductive technology" means the same as the term is defined in 42 U.S.C. Sec. 263a-7.
(1)(b) "Physician" means the same as the term is defined in Section 58-67-102.
(1)(c) "Qualified assisted reproductive technology cycle" means the use of covered assisted reproductive technology to transfer a single embryo for implantation.
(1)(d) "Qualified individual" means an individual:
(1)(d)(i) covered within the state risk pool; and
(1)(d)(ii) eligible for maternity benefits under the program.
(2) (2)(a) The program shall provide coverage for qualified assisted reproductive technology cycles.
(2)(b) The benefit is subject to the same cost sharing requirements as the qualified individual's plan.
(3) A qualified individual shall receive the benefit described in Subsection (2) if:
(3)(a) the qualified individual is the patient who will use the assisted reproductive technology;
(3)(b) (3)(b)(i) the patient's physician verifies that the patient or the patient's spouse has a demonstrated condition recognized by a physician as a cause of infertility; or
(3)(b)(ii) the patient attests that the patient is unable to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations without contraception;
(3)(c) the patient attests that the patient has been unable to attain a successful pregnancy through any less-costly, potentially effective infertility treatments for which coverage is available under the health benefit plan; and
(3)(d) the use of the assisted reproductive technology procedure complies with the program's clinical policies and is performed by a health care provider who contracts with or is otherwise approved by the program.
(4) (4)(a) The provision of a benefit in accordance with this section shall satisfy, in accordance with Subsection 31A-22-610.1(1)(c)(ii), the requirement to provide an adoption indemnity benefit to a qualified individual under Section 31A-22-610.1.
(4)(b) If a qualified individual has received the adoption indemnity benefit required under Section 31A-22-610.1, the qualified individual may not receive a benefit in accordance with this section.

Legislative History

Amended by Chapter 52, 2025 General Session