HB588: HB588 Insurance; coverage for fertility diagnostic care, treatment, and preservation services; provide

25 LC 46 1058 House Bill 588 By: Representatives Drenner of the 85th, Cannon of the 58th, Au of the 50th, and Park of the 107th A BILL TO BE ENTITLED AN ACT To amend Article 1 of Chapter 24 of Title 33 of the Official Co de of Georgia Annotated,1 relating to general provisions regarding insurance, so as to pr ovide coverage for fertility2 diagnostic care, fertility treatment, and for fertility preserv ation services; to provide for3 limitations; to provide for statutory construction; to provide for rules; to provide for certain4 policies, contracts, certificates, and renewals; to provide for definitions; to provide for related5 matters; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Article 1 of Chapter 24 of Title 33 of the Official Code of Geo rgia Annotated, relating to9 general provisions regarding insurance, is amended by adding a new Code section to read as10 follows:11 "33-24-59.30.12 (a) As used in this Code section, the term:13 (1) 'American Society for Reproductive Medicine' means the Ame rican Society for14 Reproductive Medicine or its successor organization.15 (2) 'Covered person' means an individual covered under a health benefit policy.16 H. B. 588 - 1 - 25 LC 46 1058 (3) 'Experimental fertility procedure' means a procedure for which the published medical17 evidence is not sufficient for the American Society for Reprodu ctive Medicine or a18 comparable organization to regard such procedure as an established medical practice.19 (4) 'Fertility diagnostic care' means procedures, products, medications, genetic testing,20 counseling, and services, including laboratory assessments and imaging studies, intended21 to provide information and counseling about an individual's fertility.22 (5) 'Fertility patient' means:23 (A) An individual or couple with infertility;24 (B) An individual unable to conceive as an individual or with a partner because the25 individual or couple does not have the necessary gametes for conception; or26 (C) A couple who is at increased risk of passing a serious inh eritable genetic or27 chromosomal abnormality to a child.28 (6) 'Fertility preservation services' means procedures, produc ts, medications, genetic29 testing, counseling, and services intended to preserve fertility and that are provided in a30 manner consistent with established medical practice and profess ional guidelines as31 published by the American Society for Reproductive Medicine or a comparable32 organization for an individual who has a medical condition or who is expected to receive33 medical treatment that may cause or has the potential to cause a risk of impairment of34 fertility. Such term includes, but is not limited to, evaluati on expenses, laboratory35 assessments, medications, and treatment associated with fertility preservation services,36 as well as the procurement and cryopreservation of gametes, embryos, and reproductive37 material and storage from the time of cryopreservation for a pe riod of three years;38 provided, however, that storage may be offered for a longer period of time.39 (7) 'Fertility treatment' means procedures, products, medicati ons, genetic testing,40 counseling, and services intended to achieve pregnancy that res ults in a live birth with41 healthy outcomes and that are provided in a manner consistent with established medical42 H. B. 588 - 2 - 25 LC 46 1058 practice and professional guidelines as published by the Americ an Society for43 Reproductive Medicine or a comparable organization.44 (8) 'Gamete' means sperm or eggs.45 (9) 'Infertility' means:46 (A) The inability to establish pregnancy or to carry a pregnancy to live birth after 1247 months of regular, unprotected sexual intercourse when the coup le has the necessary48 gametes for conception, or after a period of less than 12 months due to a person's age49 or other factors when the couple has the necessary gametes for conception. Pregnancy50 resulting in a loss shall not cause the time period of trying to achieve a pregnancy to be51 restarted; or52 (B) The presence of a condition recognized by a licensed physi cian that impacts an53 individual’s ability to establish pregnancy or to carry a pregnancy based on a patient's54 medical, sexual, and reproductive history, as well as age, phys ical findings, or55 diagnostic testing, or any combination of those factors.56 (b) Beginning January 1, 2026, an insurer offering a health benefit policy in this state shall57 provide coverage to a fertility patient the following:58 (1) Fertility diagnostic care;59 (2) Fertility treatment; and60 (3) Fertility preservation services.61 (c) The coverage required under this Code section shall include at least three complete egg62 retrievals with unlimited embryo transfers from those egg retri evals or from any egg63 retrieval performed prior to January 1, 2026, in accordance wit h the guidelines of the64 American Society for Reproductive Medicine or a comparable organization, using single65 embryo transfer when recommended and medically appropriate.66 (d) Fertility preservation coverage shall be provided to an individual who has a medical67 or genetic condition or who is expected to undergo treatment that may directly or indirectly68 cause a risk of impairment of fertility.69 H. B. 588 - 3 - 25 LC 46 1058 (e) An insurer providing coverage as enumerated in subsection (b) of this Code section70 shall not:71 (1) Impose a waiting period before the provision of such services;72 (2) Use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting,73 or otherwise restricting the availability of coverage required by this Code section;74 (3) Impose any limitations on coverage for any fertility services based on an enrollee's75 use of donor gametes, donor embryos, or if an embryo will be transferred to surrogate;76 or77 (4) Impose different limitations on coverage for, provide different benefits to or impose78 different requirements on a class of persons due to an individu al's actual or perceived79 race, color, religion, national origin, sex, sexual orientation, gender, mental disability, or80 physical disability.81 (f) Any limitations imposed by an insurer shall be based on an enrollee's medical history. 82 Any clinical guidelines used by an insurer shall be based on current guidelines developed83 by the American Society for Reproductive Medicine or a comparable organization, shall84 cite with specificity any data or scientific reference relied upon, shall be maintained and85 made available in writing to a covered person within three business days of such enrollee's86 request.87 (g) This Code section shall not be construed to require any insurer to provide coverage for:88 (1) Any experimental fertility procedure; or89 (2) Any nonmedical costs related to donor gametes, donor embryos, or surrogacy.90 (h) The Commissioner shall adopt rules for the implementation of this Code section,91 including, without limitation, cost-sharing, benefit design, and clinical guidelines. In the92 adoption of such rules, the Commissioner shall consider the clinical guidelines developed93 by the American Society for Reproductive Medicine or a comparable organization.94 H. B. 588 - 4 - 25 LC 46 1058 (i)(1) The provisions of this Code section shall apply to all p olicies, contracts, and95 certificates executed, delivered, issued for delivery, continued, or renewed in this state96 on or after January 1, 2026.97 (2) For purposes of this Code section, all contracts are deeme d to be renewed no later98 than the next yearly anniversary of the contract date."99 SECTION 2.100 All laws and parts of laws in conflict with this Act are repealed.101 H. B. 588 - 5 -