‘(a) Requirements for Coverage of Treatment of Infertility-
‘(1) IN GENERAL- In a case in which a group health plan, and a health insurance issuer offering group health insurance coverage provides coverage for obstetrical services, such plan or issuer shall include (consistent with this section) coverage for treatment of infertility.
‘(2) INFERTILITY DEFINED- For purposes of this section, the term ‘infertility’ means a disease or condition that results in the abnormal function of the reproductive system, which results in--
‘(A) the inability to conceive after 1 year of unprotected intercourse, or
‘(B) the inability to carry a pregnancy to live birth.
‘(b) Required Coverage-
‘(1) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage shall provide coverage for treatment of infertility deemed appropriate by a participant or beneficiary and the treating physician. Such treatment shall include ovulation induction, artificial insemination, in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), sperm collection for fertility treatments, and any other treatment provided it has been deemed as ‘non-experimental’ by the Secretary after consultation with appropriate professional and patient organizations such as the American Society for Reproductive Medicine, RESOLVE, and the American College of Obstetricians and Gynecologists.
‘(2) LIMITATION ON COVERAGE OF ASSISTED REPRODUCTIVE TECHNOLOGY-
‘(A) IN GENERAL- In the case of assisted reproductive technology, coverage shall be provided if--
‘(i) the participant or beneficiary has been unable to bring a pregnancy to a live birth through less costly medically appropriate infertility treatments for which coverage is available under the insured’s policy, plan, or contract;
‘(ii) the participant or beneficiary has not undergone 4 complete oocyte retrievals, except that if a live birth follows a completed oocyte retrieval, then at least 2 more completed oocyte retrievals shall be covered, with a lifetime cap of 6 retrievals; and
‘(iii) the treatment is performed at a medical facility that--
‘(I) conforms to the standards of the American Society for Reproductive Medicine; and
‘(II) is in compliance with any standards set by an appropriate Federal agency.
‘(B) DEFINITION OF ASSISTED REPRODUCTIVE TECHNOLOGY- For purposes of this paragraph, the term ‘assisted reproductive technology’ includes all treatments or procedures that involve the handling of human egg and sperm for the purpose of helping a woman become pregnant. Types of assisted reproductive technology include in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, embryo cryopreservation, egg or embryo donation, and surrogate birth.
‘(3) REVIEW BY THE SECRETARY- Not later than 5 years after the date of enactment of the Family Building Act of 2009, the Secretary, in consultation with the American Society for Reproductive Medicine and RESOLVE: the National Infertility Association, shall review the requirements for treatment of infertility established under paragraphs (1) and (2).
‘(c) Limitation- Deductibles, coinsurance, and other cost-sharing or other limitations for infertility therapy may not be imposed to the extent they exceed the deductibles, coinsurance, and limitations that are applied to similar services under the group health plan or health insurance coverage.
‘(d) Prohibitions- A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not--
‘(1) deny to a participant or beneficiary eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section;
‘(2) provide incentives (monetary or otherwise) to a participant or beneficiary to encourage such participant or beneficiary not to be provided infertility treatments to which they are entitled under this section or to providers to induce such providers not to provide such treatments to qualified participants or beneficiaries;
‘(3) prohibit a provider from discussing with a participant or beneficiary infertility treatment techniques or medical treatment options relating to this section; or
‘(4) penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided infertility treatments to a qualified participant or beneficiary in accordance with this section.
‘(e) Rule of Construction- Nothing in this section shall be construed to require a participant or beneficiary to undergo infertility therapy.
‘(f) Notice- A group health plan under this part shall comply with the notice requirement under section 713(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan.
‘(g) Level and Type of Reimbursements- Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
‘(h) Preemption- The provisions of this section do not preempt State law relating to health insurance coverage to the extent such State law provides greater benefits with respect to infertility treatments or prevention.’.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is amended by striking ‘section 2704’ and inserting ‘sections 2704 and 2708’.
(2) ERISA AMENDMENT- (A) Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section: