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

25 HB 94/AP House Bill 94 (AS PASSED HOUSE AND SENATE) By: Representatives Lumsden of the 12th, Taylor of the 173rd, Hawkins of the 27th, Cooper of the 45th, Silcox of the 53rd, and others A BILL TO BE ENTITLED AN ACT To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to1 insurance generally, so as to require certain health benefit policies to include coverage for2 certain expenses for standard fertility preservation services w hen a medically necessary3 treatment for cancer, sickle cell disease, or lupus may directl y or indirectly cause an4 impairment of fertility; to provide for definitions; to provide for exclusions; to allow for5 certain cost-sharing requirements; to provide for rules and regulations; to provide for related6 matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:8 SECTION 1.9 Chapter 24 of Title 33 of the Official Code of Georgia Annotate d, relating to insurance10 generally, is amended by adding a new Code section to read as follows:11 "33-24-59.34.12 (a) As used in this Code section, the term:13 (1) 'Health benefit policy' means any individual or group plan , policy, or contract for14 healthcare services issued, delivered, issued for delivery, or renewed in this state by an15 insurer that provides major medical benefits. Such term shall not include any plans,16 H. B. 94 - 1 - 25 HB 94/AP policies, or contracts executed by the state. Such term shall not include self-funded, employer17 sponsored health insurance plans subject to the exclusive juris diction of the federal18 Employee Retirement Income Security Act of 1974, as codified an d amended at 2919 U.S.C. Section 1001, et seq.20 (2) 'Iatrogenic infertility' means an impairment of fertility caused directly or indirectly21 by a medically necessary treatment for cancer, sickle cell disease, or lupus.22 (3) 'Insurer' means any person, corporation, or other entity authorized to provide health23 benefit policies under this title, including a healthcare corporation, health maintenance24 organization, preferred provider organization, accident and sic kness insurer, fraternal25 benefit society, hospital service corporation, medical service corporation, or any similar26 entity.27 (4) 'Medically necessary treatment' means a medically necessary treatment for cancer,28 sickle cell disease, or lupus that has a potential side effect of iatrogenic infertility. Such29 treatment includes but is not limited to the surgical removal of the primary or secondary30 reproductive organs, chemotherapy, radiation therapy, and bone marrow transplantation.31 (5) 'Standard fertility preservation services' means procedures to preserve fertility that32 are consistent with established medical practices or profession al guidelines. Such33 services include but are not limited to egg, sperm, embryo, and ovarian tissue34 cryopreservation.35 (b) Every health benefit policy renewed or issued after Januar y 1, 2026, shall include36 coverage for expenses for standard fertility preservation servi ces when a medically37 necessary treatment may directly or indirectly cause iatrogenic infertility in any covered38 person. Such coverage shall include evaluation expenses, labor atory assessments,39 medications, and treatments associated with standard fertility preservation services,40 including storage of gametes for up to one year.41 (c) The coverage provided for in subsection (b) of this Code section may:42 (1) Exclude costs associated with storage of gametes for more than one year;43 H. B. 94 - 2 - 25 HB 94/AP (2) Include age restrictions;44 (3) Include a lifetime limit per procedure per eligible insured; and45 (4) Be limited to nonexperimental procedures.46 (d) The benefits in a health benefit policy as provided in sub section (b) of this Code47 section shall be subject to the same deductibles, coinsurance, and copayment provisions48 established for all covered benefits within such health benefit policy. Special deductibles,49 coinsurance, copayment, or other limitations that are not gener ally applicable to other50 hospital, medical, or surgical services covered by a health ben efit policy shall not be51 imposed on coverage for standard fertility preservation services.52 (e) The Commissioner shall promulgate rules and regulations necessary to implement the53 provisions of this Code section in accordance with current guid elines established by54 professional medical organizations such as the American Society of Clinical Oncology or55 the American Society for Reproductive Medicine."56 SECTION 2.57 This Act shall become effective upon its approval by the Governor or upon its becoming law58 without such approval.59 SECTION 3.60 All laws and parts of laws in conflict with this Act are repealed.61 H. B. 94 - 3 -