Access to Fertility Treatment and Care Act

The "Access to Fertility Treatment and Care Act" seeks to broaden access to fertility treatment by requiring various health insurance plans to offer comprehensive coverage. This legislation mandates that group health plans and health insurance issuers, whether offering group or individual coverage, must cover fertility treatment if they already provide obstetrical services. This coverage is required when deemed appropriate by a healthcare provider, regardless of an infertility diagnosis, provided the treatment is performed at a medical facility compliant with federal standards. The bill provides a broad definition of "fertility treatment," encompassing crucial services such as the preservation of human oocytes, sperm, or embryos, various forms of artificial insemination, and assisted reproductive technologies like in vitro fertilization (IVF) . It also includes genetic testing of embryos, prescribed fertility medications, and gamete donation. To ensure equitable access, the bill specifies that cost-sharing, including deductibles and coinsurance, for fertility treatments cannot exceed that applied to other medical services, unless the limitation is more favorable to fertility treatment. Furthermore, the Act prohibits health plans from offering incentives to discourage fertility treatment, restricting provider discussions, or penalizing providers for offering medically appropriate care. It also forbids discrimination in coverage based on grounds prohibited by civil rights laws. These requirements extend to federal programs, including the Federal Employees Health Benefits Program (FEHBP) , TRICARE for military personnel, and mandates the Department of Veterans Affairs to furnish fertility services to veterans and their partners. Finally, the bill integrates fertility treatment into Medicaid as part of family planning services and establishes Medicare coverage for fertility treatment, waiving deductibles and coinsurance for these services. Health plans are required to provide clear notice of this coverage to participants. The provisions generally take effect for plan years beginning six months after enactment, with specific dates for federal programs and a potential delay for state Medicaid plans requiring legislative changes.