SF1961

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.