H.R. 4648: Access to Fertility Treatment and Care Act

The Access to Fertility Treatment and Care Act is designed to expand health insurance coverage for various fertility treatments. The key points of the bill are as follows:

Health Insurance Coverage Requirements

Health insurance plans that provide obstetrical services will be required to also cover fertility treatments. The treatments covered include:

• Preservation of human oocytes, sperm, or embryos.
• Artificial insemination methods, such as intravaginal and intrauterine insemination.
• Assisted reproductive technology, including in vitro fertilization.
• Genetic testing of embryos.
• Fertility-related medications, whether prescribed or available over-the-counter.
• Gamete donation.
• Any other fertility-related services deemed appropriate by federal regulations.

Coverage Without Diagnosis

Insurance plans will have to provide fertility treatment coverage regardless of whether the patient has been diagnosed with infertility, as long as the treatment is deemed appropriate by a healthcare provider and takes place at a compliant medical facility.

Cost-Sharing and Limitations

The bill prohibits insurance plans from imposing higher deductibles or coinsurance for fertility treatments than those applied to other medical services. Any limitations or cost-sharing requirements must not be more restrictive than those for other medical services.

Incentives and Prohibitions

Insurance providers cannot offer incentives to encourage individuals not to seek fertility treatments or penalize providers for delivering such treatments. They must also allow doctors to discuss fertility options with their patients without restrictions.

Notification Requirements

Health plans will be required to inform enrollees about their coverage for fertility treatments through written notices prominently displayed in their communications.

Applicability to Various Programs

The bill also extends these requirements to several programs, including:

• The Federal Employees Health Benefits Program.
• The TRICARE program for military families.
• Fertility treatment services for veterans and their spouses or partners.
• State Medicaid programs, mandating coverage for fertility treatments.
• Medicare, ensuring coverage for fertility treatments without additional cost-sharing beyond the standard applicable amounts.

Effective Dates

The amendments of the bill would apply to plan years starting six months after the bill's enactment. Special provisions are made for collective bargaining agreements, and certain requirements for state Medicaid plans would take effect gradually, starting from October 1, 2026.

Regulations and Administration

The bill grants the Secretary of Health and Human Services the authority to establish appropriate regulations to govern the implementation of these coverage requirements and to ensure compliance with the provisions of the act.

Relevant Companies

None found