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SF1961 (Legislative Session 94 (2025-2026))

Infertility treatment and standard fertility preservation services coverage by health plans requirement, MinnesotaCare and medical assistance coverage of infertility treatment and standard fertility preservation services requirement, and appropriation

Related bill: HF1758

AI Generated Summary

The bill, S.F. No. 1961, proposes requiring health insurance plans, including Medical Assistance and MinnesotaCare, to cover infertility treatment and standard fertility preservation services in Minnesota. It outlines the scope, definitions, required coverage, cost-sharing restrictions, and reimbursement procedures for health plans.

Key Provisions:

  1. Applicability: The law applies to all health plans that provide maternity benefits to Minnesota residents.
  2. Definitions:
    • Infertility treatment includes procedures and medications recommended by medical guidelines (American College of Obstetricians and Gynecologists or American Society for Reproductive Medicine).
    • Infertility is defined based on failure to conceive or carry a pregnancy after a certain period or a diagnosis by a healthcare provider.
    • Standard fertility preservation services cover procedures for individuals at risk of infertility due to medical conditions or treatments (e.g., chemotherapy).
  3. Coverage Requirements: Health plans must cover diagnosis/treatment for infertility and fertility preservation services.
    • Must include unlimited embryo transfers but may limit oocyte retrievals to four.
    • Single embryo transfer is required when medically appropriate.
    • Coverage for surgical reversal of elective sterilization is not required.
  4. Cost-Sharing Restrictions: Health plans cannot impose cost-sharing greater than those for maternity care (copayments, deductibles, coinsurance).
  5. Exclusions & Limitations: Plans cannot impose additional benefit maximums, waiting periods, or referral requirements beyond what is generally applied to maternity coverage.
    • No additional restrictions on fertility medications or services involving third parties.
  6. Reimbursement & Funding:
    • The commissioner of commerce must reimburse health plan providers for the cost of additional benefits required under this law.
    • Health plans must report additional costs related to these benefits.
    • An annual appropriation ensures funding is available for insurer reimbursements.

Purpose:

The bill aims to ensure equitable access to infertility treatments and fertility preservation services in Minnesota by mandating insurance coverage and providing financial support to insurers.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
February 26, 2025SenateFloorActionIntroduction and first reading
February 26, 2025SenateFloorActionReferred toCommerce and Consumer Protection

Citations

 
[
  {
    "analysis": {
      "added": [
        "A new subdivision to cover infertility treatment and standard fertility preservation services."
      ],
      "removed": [
        "No specific removals noted."
      ],
      "summary": "The bill amends section 256B.0625 regarding medical assistance coverage.",
      "modified": [
        "Expands coverage details and requirements within the existing framework."
      ]
    },
    "citation": "256B.0625"
  },
  {
    "analysis": {
      "added": [
        "A new subsection clarifying disbursement rules."
      ],
      "removed": [
        "Eliminates previous requirement for municipal matching funds."
      ],
      "summary": "This citation refers to modifications in pension fund eligibility for volunteer firefighters.",
      "modified": [
        "Adjusts pension payment schedule from annual to quarterly."
      ]
    },
    "citation": "353G.06"
  },
  {
    "analysis": {
      "added": [
        "Aligns reimbursement with federal rules for health coverage provisions."
      ],
      "removed": [
        "No specific removals noted."
      ],
      "summary": "Reference to federal regulation for the purpose of reimbursement under new health coverage requirements.",
      "modified": [
        "Reimbursement procedures linked to this federal regulation."
      ]
    },
    "citation": "Code of Federal Regulations title 45 section 155.170"
  }
]

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