Senate Bill 1680

CODING: Words stricken are deletions; words underlined are additions.



    Florida Senate - 1999                                  SB 1680

    By Senator Klein





    28-909-99                                           See HB 629

  1                      A bill to be entitled

  2         An act relating to health insurance coverage

  3         for infertility; creating ss. 627.64062,

  4         627.65742, F.S., and amending s. 641.31, F.S.;

  5         requiring coverage by health insurance

  6         policies, group, franchise, and blanket health

  7         insurance policies, and health maintenance

  8         contracts for diagnosis and treatment of

  9         infertility under certain circumstances;

10         providing requirements and criteria; providing

11         limitations; providing definitions; providing

12         an exception for certain religious

13         organizations; providing application; excluding

14         payments for donor eggs or certain medical

15         services; amending ss. 627.651, 627.6515,

16         627.6699, F.S.; providing for application to

17         group contracts and plans of self insurance,

18         out-of-state groups, and standard, basic, and

19         limited health benefit plans; providing an

20         effective date.

21

22  Be It Enacted by the Legislature of the State of Florida:

23

24         Section 1.  Section 627.64062, Florida Statutes, is

25  created to read:

26         627.64062  Coverage of diagnosis and treatment of

27  infertility.--

28         (1)  Any health insurance policy that provides coverage

29  for pregnancy-related benefits shall also provide coverage for

30  the diagnosis and treatment of infertility, including all

31

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1  nonexperimental assisted reproductive technology procedures

  2  and artificial insemination with partner or donor sperm.

  3         (2)  The coverage required under this section is

  4  subject to the following conditions:

  5         (a)  Coverage shall be subject to any deductible and

  6  coinsurance conditions and all other terms and conditions

  7  applicable to other benefits.

  8         (b)  Coverage for procedures for in vitro

  9  fertilization, gamete intrafallopian transfer, or zygote

10  intrafallopian transfer shall be required only if:

11         1.  The covered individual has been unable to carry a

12  pregnancy to live birth.

13         2.  The covered individual has been unable to carry a

14  pregnancy to live birth through less costly medically

15  appropriate infertility treatments for which coverage is

16  available under the policy, plan, or contract.

17         3.  The covered individual has not undergone 4 complete

18  oocyte retrievals.

19         4.  The procedures are performed at medical facilities

20  that conform to the standards of the American Society for

21  Reproductive Medicine, the Society for Assisted Reproductive

22  Technology, and the American College of Obstetricians and

23  Gynecologists.

24         5.  The laboratory or facility has received

25  accreditation from the Reproductive Laboratory Accreditation

26  Program of the College of American Pathologists or another

27  accreditation organization approved by the Society for

28  Assisted Reproductive Medicine.

29         (c)  In order to undergo in vitro fertilization, gamete

30  intrafallopian transfer, or zygote intrafallopian transfer, a

31  second opinion is required by a certified reproductive

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CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1  endocrinologist who is actively experienced in assisted

  2  reproductive technologies but is not in the same group as the

  3  treating physician.

  4         (d)  The provider must include at least one certified

  5  reproductive endocrinologist or a physician with fellowship

  6  training and subspecialty board eligibility in reproductive

  7  endocrinology and infertility.

  8         (3)  As used in this section the term:

  9         (a)  "Pregnancy-related benefits" means benefits that

10  cover any related medical condition that may be associated

11  with pregnancy, including complications of pregnancy.

12         (b)  "Infertility" means a disease or condition

13  affecting the reproductive system that interferes with the

14  ability of a man or woman to achieve a pregnancy or of a woman

15  to carry a pregnancy to live birth.  The duration of the

16  failure to conceive should be 12 or more months before an

17  investigation is undertaken unless medical history and

18  physical findings dictate earlier evaluation and treatment.

19         (c)  "Nonexperimental procedure" means any clinical

20  treatment or procedure the safety and efficacy of which is

21  recognized as such by the American Society for Reproductive

22  Medicine or the American College of Obstetricians and

23  Gynecologists.

24         (4)  Nothing in this section applies to any health

25  insurance policy which is purchased by an entity, group, or

26  order that is directly affiliated with a bona fide religious

27  denomination that includes as an integral part of its beliefs

28  and practices the tenet that drug therapy for infertility or

29  in vitro fertilization services are contrary to the moral

30  principles that the religious denomination considers to be an

31  essential part of its beliefs.

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CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         (5)  This section applies to benefits for the state

  2  group insurance program under s. 110.123.

  3         (6)  This section does not apply to payment for donor

  4  eggs or medical services rendered to a surrogate for purposes

  5  of child birth.

  6         Section 2.  Subsection (4) of section 627.651, Florida

  7  Statutes, is amended to read:

  8         627.651  Group contracts and plans of self-insurance

  9  must meet group requirements.--

10         (4)  This section does not apply to any plan which is

11  established or maintained by an individual employer in

12  accordance with the Employee Retirement Income Security Act of

13  1974, Pub. L. No. 93-406, or to a multiple-employer welfare

14  arrangement as defined in s. 624.437(1), except that a

15  multiple-employer welfare arrangement shall comply with ss.

16  627.419, 627.657, 627.65742, 627.6575, 627.6576, 627.6578,

17  627.6579, 627.6612, 627.66121, 627.66122, 627.6615, 627.6616,

18  and 627.662(6).  This subsection does not allow an authorized

19  insurer to issue a group health insurance policy or

20  certificate which does not comply with this part.

21         Section 3.  Paragraph (c) of subsection (2) of section

22  627.6515, Florida Statutes, 1998 Supplement, is amended to

23  read:

24         627.6515  Out-of-state groups.--

25         (2)  This part does not apply to a group health

26  insurance policy issued or delivered outside this state under

27  which a resident of this state is provided coverage if:

28         (c)  The policy provides the benefits specified in ss.

29  627.419, 627.6574, 627.65742, 627.6575, 627.6579, 627.6612,

30  627.66121, 627.66122, 627.6613, 627.667, 627.6675, 627.6691,

31  and 627.66911.

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         Section 4.  Section 627.65742, Florida Statutes, is

  2  created to read:

  3         627.65742  Coverage of diagnosis and treatment of

  4  infertility.--

  5         (1)  Any group, franchise, or blanket health insurance

  6  policy that provides coverage for pregnancy-related benefits

  7  shall also provide coverage for the diagnosis and treatment of

  8  infertility, including all nonexperimental assisted

  9  reproductive technology procedures and artificial insemination

10  with partner or donor sperm.

11         (2)  The coverage required under this section is

12  subject to the following conditions:

13         (a)  Coverage may not be subject to copayments or

14  deductible requirements which are greater than those applied

15  to pregnancy-related benefits under the insured's policy,

16  plan, or contract.

17         (b)  Coverage for procedures for in vitro

18  fertilization, gamete intrafallopian transfer, or zygote

19  intrafallopian transfer shall be required only if:

20         1.  The covered individual has been unable to carry a

21  pregnancy to live birth.

22         2.  The covered individual has been unable to carry a

23  pregnancy to live birth through less costly medically

24  appropriate infertility treatments for which coverage is

25  available under the policy, plan, or contract.

26         3.  The covered individual has not undergone 4 complete

27  oocyte retrievals.

28         4.  The procedures are performed at medical facilities

29  that conform to the standards of the American Society for

30  Reproductive Medicine, the Society for Assisted Reproductive

31

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1  Technology, and the American College of Obstetricians and

  2  Gynecologists.

  3         5.  The laboratory or facility has received

  4  accreditation from the Reproductive Laboratory Accreditation

  5  Program of the College of American Pathologists or another

  6  accreditation organization approved by the Society for

  7  Assisted Reproductive Medicine.

  8         (c)  In order to undergo in vitro fertilization, gamete

  9  intrafallopian transfer, or zygote intrafallopian transfer, a

10  second opinion is required by a certified reproductive

11  endocrinologist who is actively experienced in assisted

12  reproductive technologies but is not in the same group as the

13  treating physician.

14         (d)  The provider must include at least one certified

15  reproductive endocrinologist or a physician with fellowship

16  training and subspecialty board eligibility in reproductive

17  endocrinology and infertility.

18         (3)  As used in this section:

19         (a)  "Pregnancy-related benefits" means benefits that

20  cover any related medical condition that may be associated

21  with pregnancy, including complications of pregnancy.

22         (b)  "Infertility" means a disease or condition

23  affecting the reproductive system that interferes with the

24  ability of a man or woman to achieve a pregnancy or of a woman

25  to carry a pregnancy to live birth.  The duration of the

26  failure to conceive should be 12 or more months before an

27  investigation is undertaken unless medical history and

28  physical findings dictate earlier evaluation and treatment.

29         (c)  "Nonexperimental procedure" means any clinical

30  treatment or procedure the safety and efficacy of which is

31  recognized as such by the American Society for Reproductive

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1  Medicine or the American College of Obstetricians and

  2  Gynecologists.

  3         (4)  Nothing in this section applies to any group,

  4  franchise, or blanket health insurance policy that is

  5  purchased by an entity, group, or order that is directly

  6  affiliated with a bona fide religious denomination that

  7  includes as an integral part of its beliefs and practices the

  8  tenet that drug therapy for infertility or in vitro

  9  fertilization services are contrary to the moral principles

10  that the religious denomination considers to be an essential

11  part of its beliefs.

12         (5)  This section does not apply to payment for donor

13  eggs or medical services rendered to a surrogate for purposes

14  of child birth.

15         Section 5.  Paragraph (b) of subsection (12) of section

16  627.6699, Florida Statutes, 1998 Supplement, is amended to

17  read:

18         627.6699  Employee Health Care Access Act.--

19         (12)  STANDARD, BASIC, AND LIMITED HEALTH BENEFIT

20  PLANS.--

21         (b)1.  Each small employer carrier issuing new health

22  benefit plans shall offer to any small employer, upon request,

23  a standard health benefit plan and a basic health benefit plan

24  that meets the criteria set forth in this section.

25         2.  For purposes of this subsection, the terms

26  "standard health benefit plan" and "basic health benefit plan"

27  mean policies or contracts that a small employer carrier

28  offers to eligible small employers that contain:

29         a.  An exclusion for services that are not medically

30  necessary or that are not covered preventive health services;

31  and

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         b.  A procedure for preauthorization by the small

  2  employer carrier, or its designees.

  3         3.  A small employer carrier may include the following

  4  managed care provisions in the policy or contract to control

  5  costs:

  6         a.  A preferred provider arrangement or exclusive

  7  provider organization or any combination thereof, in which a

  8  small employer carrier enters into a written agreement with

  9  the provider to provide services at specified levels of

10  reimbursement or to provide reimbursement to specified

11  providers. Any such written agreement between a provider and a

12  small employer carrier must contain a provision under which

13  the parties agree that the insured individual or covered

14  member has no obligation to make payment for any medical

15  service rendered by the provider which is determined not to be

16  medically necessary.  A carrier may use preferred provider

17  arrangements or exclusive provider arrangements to the same

18  extent as allowed in group products that are not issued to

19  small employers.

20         b.  A procedure for utilization review by the small

21  employer carrier or its designees.

22

23  This subparagraph does not prohibit a small employer carrier

24  from including in its policy or contract additional managed

25  care and cost containment provisions, subject to the approval

26  of the department, which have potential for controlling costs

27  in a manner that does not result in inequitable treatment of

28  insureds or subscribers.  The carrier may use such provisions

29  to the same extent as authorized for group products that are

30  not issued to small employers.

31         4.  The standard health benefit plan shall include:

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         a.  Coverage for inpatient hospitalization;

  2         b.  Coverage for outpatient services;

  3         c.  Coverage for newborn children pursuant to s.

  4  627.6575;

  5         d.  Coverage for child care supervision services

  6  pursuant to s. 627.6579;

  7         e.  Coverage for adopted children upon placement in the

  8  residence pursuant to s. 627.6578;

  9         f.  Coverage for mammograms pursuant to s. 627.6613;

10         g.  Coverage for handicapped children pursuant to s.

11  627.6615;

12         h.  Emergency or urgent care out of the geographic

13  service area; and

14         i.  Coverage for services provided by a hospice

15  licensed under s. 400.602 in cases where such coverage would

16  be the most appropriate and the most cost-effective method for

17  treating a covered illness.

18         5.  The standard health benefit plan and the basic

19  health benefit plan may include a schedule of benefit

20  limitations for specified services and procedures.  If the

21  committee develops such a schedule of benefits limitation for

22  the standard health benefit plan or the basic health benefit

23  plan, a small employer carrier offering the plan must offer

24  the employer an option for increasing the benefit schedule

25  amounts by 4 percent annually.

26         6.  The basic health benefit plan shall include all of

27  the benefits specified in subparagraph 4.; however, the basic

28  health benefit plan shall place additional restrictions on the

29  benefits and utilization and may also impose additional cost

30  containment measures.

31

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         7.  Sections 627.419(2), (3), and (4), 627.6574,

  2  627.65742, 627.6612, 627.66121, 627.66122, 627.6616, 627.6618,

  3  627.668, and 627.66911 apply to the standard health benefit

  4  plan and to the basic health benefit plan. However,

  5  notwithstanding said provisions, the plans may specify limits

  6  on the number of authorized treatments, if such limits are

  7  reasonable and do not discriminate against any type of

  8  provider.

  9         8.  Each small employer carrier that provides for

10  inpatient and outpatient services by allopathic hospitals may

11  provide as an option of the insured similar inpatient and

12  outpatient services by hospitals accredited by the American

13  Osteopathic Association when such services are available and

14  the osteopathic hospital agrees to provide the service.

15         Section 6.  Subsection (36) is added to section 641.31,

16  Florida Statutes, 1998 Supplement, is amended to read:

17         641.31  Health maintenance contracts.--

18         (36)(a)  Any health maintenance contract that provides

19  coverage for pregnancy-related benefits shall also provide

20  coverage for the diagnosis and treatment of infertility,

21  including all nonexperimental assisted reproductive technology

22  procedures and artificial insemination with partner or donor

23  sperm.

24         (b)  The coverage required under this subsection is

25  subject to the following conditions:

26         1.  Coverage shall be subject to any deductible and

27  coinsurance conditions and all other terms and conditions

28  applicable to other benefits. 

29         2.  Coverage for procedures for in vitro fertilization,

30  gamete intrafallopian transfer, or zygote intrafallopian

31  transfer shall be required only if:

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         a.  The covered individual has been unable to carry a

  2  pregnancy to live birth.

  3         b.  The covered individual has been unable to carry a

  4  pregnancy to live birth through less costly medically

  5  appropriate infertility treatments for which coverage is

  6  available under the policy, plan, or contract.

  7         c.  The covered individual has not undergone 4 complete

  8  oocyte retrievals.

  9         d.  The procedures are performed at medical facilities

10  that conform to the standards of the American Society for

11  Reproductive Medicine, the Society for Assisted Reproductive

12  Technology, and the American College of Obstetricians and

13  Gynecologists.

14         e.  The laboratory or facility has received

15  accreditation from the Reproductive Laboratory Accreditation

16  Program of the College of American Pathologists or another

17  accreditation organization approved by the Society for

18  Assisted Reproductive Medicine.

19         3.  In order to undergo in vitro fertilization, gamete

20  intrafallopian transfer, or zygote intrafallopian transfer, a

21  second opinion is required by a certified reproductive

22  endocrinologist who is actively experienced in assisted

23  reproductive technologies but is not in the same group as the

24  treating physician.

25         4.  The provider must include at least one certified

26  reproductive endocrinologist or a physician with fellowship

27  training and subspecialty board eligibility in reproductive

28  endocrinology and infertility.

29         (c)  As used in this subsection:

30

31

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1         1.  "Pregnancy-related benefits" means benefits that

  2  cover any related medical condition that may be associated

  3  with pregnancy, including complications of pregnancy.

  4         2.  "Infertility" means a disease or condition

  5  affecting the reproductive system that interferes with the

  6  ability of a man or woman to achieve a pregnancy or of a woman

  7  to carry a pregnancy to live birth.  The duration of the

  8  failure to conceive should be 12 or more months before an

  9  investigation is undertaken unless medical history and

10  physical findings dictate earlier evaluation and treatment.

11         3.  "Nonexperimental procedure" means any clinical

12  treatment or procedure whose safety and efficacy is recognized

13  as such by the American Society for Reproductive Medicine or

14  the American College of Obstetricians and Gynecologists.

15         (d)  Nothing in this subsection applies to any health

16  maintenance contract that is purchased by an entity, group, or

17  order that is directly affiliated with a bona fide religious

18  denomination that includes as an integral part of its beliefs

19  and practices the tenet that drug therapy for infertility or

20  in vitro fertilization services are contrary to the moral

21  principles that the religious denomination considers to be an

22  essential part of its beliefs.

23         (e)  This subsection applies to benefits for the state

24  group insurance program under s. 110.123.

25         (f)  This subsection does not apply to payment for

26  donor eggs or medical services rendered to a surrogate for

27  purposes of child birth.

28         Section 7.  This act shall take effect October 1, 1999.

29

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    Florida Senate - 1999                                  SB 1680
    28-909-99                                           See HB 629




  1            *****************************************

  2                       LEGISLATIVE SUMMARY

  3
      Requires coverage by health insurance policies, group,
  4    franchise, and blanket health insurance policies, and
      health maintenance contracts for diagnosis and treatment
  5    of infertility.  Provides an exception for religious
      organizations.  Applies the requirement to group
  6    contracts and plans of self insurance, out-of-state
      groups, and standard, basic, and limited health benefit
  7    plans. (See bill for details.)

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