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7 LONG TITLE
8 General Description:
9 This bill requires certain health benefit plans to cover in vitro fertilization.
10 Highlighted Provisions:
11 This bill:
12 ▸ requires a health benefit plan to cover in vitro fertilization if it provides a maternity
13 benefit;
14 ▸ specifies eligibility, cost sharing, and other coverage requirements; and
15 ▸ creates an exemption.
16 Money Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 ENACTS:
22 31A-22-653, Utah Code Annotated 1953
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24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-653 is enacted to read:
26 31A-22-653. Coverage of in vitro fertilization.
27 (1) A health benefit plan entered into or renewed on or after January 1, 2021, that
28 includes a maternity benefit shall cover an in vitro fertilization procedure in accordance with
29 this section.
30 (2) An enrollee is eligible for coverage of an in vitro fertilization procedure if:
31 (a) the enrollee and the enrollee's spouse have a history of infertility:
32 (i) associated with:
33 (A) endometriosis;
34 (B) exposure to diethylstilbestrol in utero;
35 (C) blockage or surgical removal of one or both fallopian tubes; or
36 (D) oligospermia; or
37 (ii) that has lasted for at least the previous five years;
38 (b) the fertilization or attempted fertilization of the enrollee's oocytes is made with the
39 sperm of the enrollee's spouse;
40 (c) the enrollee has been unable to achieve a successful pregnancy using other
41 medically appropriate infertility treatments that:
42 (i) are covered by the health benefit plan; and
43 (ii) cost less than the in vitro fertilization procedure;
44 (d) the in vitro fertilization procedure is performed in accordance with guidelines
45 adopted by the American Society for Reproductive Medicine; and
46 (e) the enrollee has not received from the health benefit plan an adoption indemnity
47 benefit under Section 31A-22-610.1 or Section 49-20-418.
48 (3) (a) A health benefit plan's cost sharing requirements for coverage of an in vitro
49 fertilization procedure may not be less favorable to an enrollee than the cost sharing
50 requirements for the health benefit plan's maternity benefit.
51 (b) A health benefit plan's coverage of an vitro fertilization procedure may not include
52 benefit limits less favorable to an enrollee than maternity benefit limits imposed by the health
53 benefit plan.