1     
INFERTILITY TREATMENT COVERAGE AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Luz Escamilla

5     
House Sponsor: Rex P. Shipp

6     

7     LONG TITLE
8     Committee Note:
9          The Retirement and Independent Entities Interim Committee recommended this bill.
10               Legislative Vote:     11 voting for     0 voting against     4 absent
11     General Description:
12          This bill modifies provisions related to the expanded infertility treatment coverage
13     health benefit.
14     Highlighted Provisions:
15          This bill:
16          ▸     eliminates the scheduled repeal of the expanded infertility treatment coverage pilot
17     program;
18          ▸     makes permanent the benefit for assisted reproductive technology for individuals
19     within the state health insurance risk pool; and
20          ▸     makes technical and conforming changes.
21     Money Appropriated in this Bill:
22          None
23     Other Special Clauses:
24          This bill provides a special effective date.
25     Utah Code Sections Affected:
26     AMENDS:
27          49-20-418, as last amended by Laws of Utah 2021, Chapters 64, 195
28          63I-1-249, as last amended by Laws of Utah 2021, Chapter 195
29     

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 49-20-418 is amended to read:
32          49-20-418. Expanded infertility treatment benefit.
33          (1) As used in this section:
34          (a) "Assisted reproductive technology" means the same as the term is defined in 42
35     U.S.C. Sec. 263a-7.
36          (b) "Physician" means the same as the term is defined in Section 58-67-102.
37          [(c) "Pilot program" means the expanded infertility treatment coverage pilot program
38     described in Subsection (2).]
39          [(d)] (c) "Qualified assisted reproductive technology cycle" means the use of assisted
40     reproductive technology to transfer a single embryo for implantation.
41          [(e)] (d) "Qualified individual" means [a covered] an individual who is:
42          (i) covered within the state risk pool; and
43          (ii) eligible for maternity benefits under the program.
44          [(2) (a) Beginning plan year 2018-19, and ending plan year 2023-24, the program shall
45     offer a pilot program within the state risk pool that provides coverage to a qualified individual
46     for the use of an assisted reproductive technology.]
47          [(b) (i) For plan year 2018-19, 2019-20, or 2020-21, the pilot program shall offer a
48     one-time benefit of $4,000 toward the costs of using an assisted reproductive technology for
49     each qualified individual.]
50          [(ii) For plan year 2021-22, 2022-23, or 2023-24, the pilot] (2) (a) The program shall
51     offer a benefit of $4,000 to a qualified individual toward the costs of each qualified assisted
52     reproductive technology cycle.
53          [(c) The benefits described in Subsection (2)(b) are] (b) The benefit is subject to the
54     same cost sharing requirements as the [covered] qualified individual's plan.
55          (3) [Coverage offered under the pilot program applies if:] A qualified individual shall
56     receive the benefit described in Subsection (2) if:
57          (a) the qualified individual is the patient who will use the assisted reproductive
58     technology [is a qualified individual];
59          (b) (i) the patient's physician verifies that the patient or the patient's spouse has a
60     demonstrated condition recognized by a physician as a cause of infertility; or
61          (ii) the patient attests that the patient is unable to conceive a pregnancy or carry a
62     pregnancy to a live birth after a year or more of regular sexual relations without contraception;
63          (c) the patient attests that the patient has been unable to attain a successful pregnancy
64     through any less-costly, potentially effective infertility treatments for which coverage is
65     available under the health benefit plan; and
66          (d) the use of the assisted reproductive technology procedure complies with the
67     program's clinical policies and is performed at a medical facility that conforms to the minimal
68     standards for programs of assisted reproductive technology procedures adopted by the
69     American Society for Reproductive Medicine.
70          [(4) Coverage offered under the pilot program:]
71          (4) (a) The provision of a benefit in accordance with this section shall satisfy, in
72     accordance with Subsection 31A-22-610.1(1)(c)(ii), the requirement to provide an adoption
73     indemnity benefit to a qualified individual under Section 31A-22-610.1[;].
74          (b) [does not apply to a qualified individual if the] If a qualified individual has received
75     the adoption indemnity benefit required under Section 31A-22-610.1[; and], the qualified
76     individual may not receive a benefit in accordance with this section.
77          [(c) for plan year 2021-22, 2022-23, or 2023-24, shall apply to a qualified individual,
78     even if the qualified individual received the benefit described in Subsection (2)(b)(i).]
79          [(5) (a) The purpose of the pilot program is to study the efficacy of providing coverage
80     for the use of an assisted reproductive technology and is not a mandate for coverage of an
81     assisted reproductive technology within all health plans offered by the program.]
82          [(b) The program shall report to the Retirement and Independent Entities Interim
83     Committee regarding the costs and benefits of the pilot program:]
84          [(i) on or before October 1; and]
85          [(ii) during calendar years 2022 and 2023.]
86          [(6) Under Section 63J-1-603, the Legislature intends that the cost of the pilot program
87     will be paid from money above the minimum recommended level in the public employees' state
88     risk pool reserve.]
89          Section 2. Section 63I-1-249 is amended to read:
90          63I-1-249. Repeal dates: Title 49.
91          [(1)] Title 49, Chapter 11, Part 13, Phased Retirement, is repealed January 1, 2025.
92          [(2) Section 49-20-418 is repealed January 1, 2025.]
93          Section 3. Effective date.
94          This bill takes effect on July 1, 2024.