SF3615

Purpose

• This bill would require health plans that provide maternity benefits to cover infertility treatment and standard fertility preservation services, and it would require MinnesotaCare to do the same. It also creates a framework for state reimbursement to health plans for some of the added costs.

Scope and Definitions

• Applies to all health plans that offer maternity benefits to Minnesota residents.
• Key terms defined:
  • Infertility: a disease or condition where a person with a uterus cannot achieve a pregnancy or carry to live birth after a set period (12 months for people under 35; 6 months for people 35 and older), or based on a licensed health care provider’s determination that infertility is present.
  • Diagnosis of and treatment for infertility: procedures and medications to diagnose or treat infertility, aligned with established medical guidelines.
  • Standard fertility preservation services: procedures tied to medical conditions or treatments (like medications, surgery, radiation, chemotherapy) that could impair fertility, following recognized guidelines.
  • Fertility medications: drugs used to support fertility treatment, with protections against stricter limits than other prescription meds.

What Must Be Covered (Main Provisions)

• Required coverage:
  • Health plans must cover the diagnosis of infertility, treatment for infertility, and standard fertility preservation services.
  • MinnesotaCare must also cover infertility treatment and standard fertility preservation services.
• Embryo transfers and oocyte retrievals:
  • Plans must cover unlimited embryo transfers.
  • A limit may be placed on oocyte retrievals: up to four completed retrievals, with single embryo transfer used when medically appropriate.
• Reversal of sterilization:
  • Coverage for surgical reversal of elective sterilization is not required.
• Cost-sharing:
  • Cost-sharing for infertility coverage cannot exceed the cost-sharing for maternity coverage (no higher copayments, deductibles, or coinsurance).
• Exclusions and limitations:
  • No benefit maximums, waiting periods, utilization reviews, referral requirements, or other typical limitations on infertility coverage beyond what applies to maternity coverage.
  • Fertility medications and fertility services cannot be more restricted than other prescription meds or based on enrollment in fertility services with third parties.

Reimbursement, Reporting, and State Funding (How the State Helps Offset Costs)

• Reimbursement by the state:
  • The commissioner of commerce must reimburse health plan companies for the added coverage created by this bill.
  • Reimbursement only covers the portion of coverage that the health plan would not have provided without this section.
  • Treatments and services already covered as of January 1, 2026 are not eligible for reimbursement under this provision.
  • Plans must report to the commissioner the quantified costs attributable to the additional benefit.
  • Reimbursement payments are determined under federal regulations (45 C.F.R. 155.170).
• Appropriation and future funding:
  • Beginning in fiscal year 2028, an amount from the general fund will be appropriated to the commissioner of commerce to cover defrayment payments, including administrative costs.

Implementation Timeline and Other Notes

• The bill would amend existing Minnesota statutes to add these requirements and create the reimbursement framework.
• It sets a baseline related to what is covered as of January 1, 2026 for purposes of reimbursement eligibility, meaning new costs beyond what was in place by that date are eligible for state defrayal.

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Relevant Terms - infertility - infertility treatment - standard fertility preservation services - diagnosis of infertility - embryo transfers (unlimited) - oocyte retrievals (up to four) - single embryo transfer - fertility medications - elective sterilization reversal - maternity coverage - cost-sharing - copayment - deductible - coinsurance - exemptions and limitations - health plan - MinnesotaCare - commissioner of commerce - reimbursement - reporting requirements - identified costs - appropriation - general fund - CFR 45.170 (federal rule reference)