HB94: HB94 Insurance; medically necessary expenses for standard fertility preservation services when a medically necessary treatment for cancer, sickle cell disease, or lupus may directly or indirectly cause an impairment of fertility; require coverage

Currently, Georgia law does not require health insurance plans to cover fertility preservation for patients whose cancer, sickle cell disease, or lupus treatment might leave them infertile. This bill changes that by adding a new section to Georgia's insurance code (O.C.G.A. § 33-24-59.34). Starting with policies issued or renewed after January 1, 2026, most individual and group health benefit policies in Georgia must cover standard fertility preservation services, such as freezing eggs, sperm, embryos, or ovarian tissue, when a medically necessary treatment for one of these three conditions could cause infertility as a side effect. Coverage includes evaluations, lab work, medications, and up to one year of gamete storage. Insurers may still apply age limits, lifetime limits per procedure, and normal cost-sharing rules, and may exclude experimental procedures or storage beyond one year. The bill exempts state-executed plans and self-funded employer plans governed by federal law.

• Adds a new Georgia insurance code section requiring covered health benefit policies to pay for standard fertility preservation services tied to cancer, sickle cell disease, or lupus treatment.
• Defines 'iatrogenic infertility' as infertility caused directly or indirectly by a medically necessary treatment for these three conditions.
• Requires coverage of evaluations, lab assessments, medications, and treatments related to fertility preservation, plus up to one year of gamete storage.
• Allows insurers to apply age restrictions, per-procedure lifetime limits, and to exclude experimental procedures or storage beyond one year.
• Bars insurers from imposing special deductibles or copays on this coverage that are not already applied to other covered medical services.
• Directs the Insurance Commissioner to write rules matching guidelines from groups like the American Society of Clinical Oncology or the American Society for Reproductive Medicine.

People in Georgia undergoing treatment for cancer, sickle cell disease, or lupus whose treatment could cause infertility; insurers offering individual or group health benefit policies in the state; and the state Insurance Commissioner, who must write implementing rules. Self-funded employer plans governed by federal law and state-run plans are excluded.

Patients facing infertility-causing treatments for cancer, sickle cell disease, or lupus would gain guaranteed insurance coverage for freezing eggs, sperm, or embryos before treatment starts, potentially preserving their ability to have children later without paying entirely out of pocket for those procedures.

• Section 1 adds new Code Section 33-24-59.34, defining key terms including 'health benefit policy,' 'iatrogenic infertility,' 'insurer,' 'medically necessary treatment,' and 'standard fertility preservation services.'
• Subsection (b) requires coverage for policies issued or renewed after January 1, 2026, including evaluations, lab tests, medications, and up to one year of gamete storage.
• Subsection (c) permits insurers to exclude storage beyond one year, apply age restrictions, set per-procedure lifetime limits, and limit coverage to nonexperimental procedures.
• Subsection (d) requires the same deductibles, coinsurance, and copays as other covered services, prohibiting extra cost-sharing burdens specific to this coverage.
• Subsection (e) directs the Insurance Commissioner to issue rules aligned with guidelines from professional medical organizations.
• Section 2 makes the law effective immediately upon the Governor's signature or upon becoming law without signature.

1. 2025-05-01Effective Date 2025-05-01
2. 2025-05-01Act 42
3. 2025-05-01House Date Signed by Governor (House)
4. 2025-04-08House Sent to Governor (House)
5. 2025-04-02House Agreed Senate Amend or Sub (House)
6. 2025-03-31Senate Passed/Adopted By Substitute (Senate)
7. 2025-03-31Senate Third Read (Senate)
8. 2025-03-21Senate Read Second Time (Senate)

• Eddie Lumsden (R, HD-012)Primary sponsor
• Darlene Taylor (R, HD-173)
• Lee Hawkins (R, HD-027)
• Sharon Cooper (R, HD-045)
• Deborah Silcox (R, HD-053)
• Kim Schofield (D, HD-063)
• Chuck Hufstetler (R, SD-052)

1. PassedHouse voteFebruary 27, 2025

   162 yea, 2 nay (4 not voting, 12 absent)

   Passage: House Vote #108

2. PassedSenate voteMarch 31, 2025

   52 yea, 1 nay (0 not voting, 3 absent)

   Passage By Substitute: Senate Vote #353

3. PassedHouse voteApril 2, 2025

   162 yea, 3 nay (6 not voting, 9 absent)

   Agree To Senate Substitute: House Vote #383

• health insurance coverage
• fertility preservation
• cancer treatment
• sickle cell disease
• lupus