AB 912, as amended, Quirk-Silva. Health care coverage: fertility preservation.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Under existing law, a health care service plan and a health insurer are required to offer group coverage for the treatment of infertility, as defined.
This bill would require a health care service plan and a health insurer to provide, on a large group basis, coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee or insured.
Because the bill would specify additional requirements for a health care service plan under the act, the willful violation of which would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 1374.551 is added to the Health and
2Safety Code, immediately following Section 1374.55, to read:
begin insert(a)end insertbegin insert end insert Every large group health care service plan that
4is issued, amended, or renewed on and after January 1, 2014, that
5provides hospital, medical, or surgical coverage shall include
6coverage for medically necessary expenses for standard fertility
7preservation services when a necessary medical treatment may
8directly or indirectly cause iatrogenic infertility to an enrollee.
9(b) For purposes of this section the following terms have the
10following meanings:
11(1) “Standard fertility preservation services” means procedures
12consistent with established medical practices and professional
13guidelines published by the American Society for Reproductive
14Medicine, the American Society of Clinical Oncology, or other
15reputable professional medical organizations.
16(2) “May directly or indirectly cause” means treatment with a
17likely
side effect of infertility as established by the American Society
18for Reproductive Medicine, the American Society of Clinical
19Oncology, or other reputable professional organizations.
20(c) The department may adopt regulations to implement this
21section.
Section 10119.61 is added to the Insurance Code,
23immediately following Section 10119.6, to read:
begin insert(a)end insertbegin insert end insertEvery health insurer that issues, amends, or
25renews a policy on and after January 1, 2014, that covers hospital,
26medical, or surgical expenses on a large group basis shall include
27coverage for medically necessary expenses for standard fertility
P3 1preservation services when a necessary medical treatment may
2directly or indirectly cause iatrogenic infertility to an insured.
3(b) For purposes of this section the following terms have the
4following meanings:
5(1) “Standard fertility preservation services” means procedures
6consistent with established medical practices and professional
7guidelines published by the American Society for Reproductive
8Medicine, the American Society of Clinical Oncology, or other
9reputable professional medical organizations.
10(2) “May directly or indirectly cause” means treatment with a
11likely side effect of infertility as established by the American Society
12for Reproductive Medicine, the American Society of Clinical
13Oncology, or other reputable professional organizations.
14(c) The department may adopt regulations to implement this
15section.
No reimbursement is required by this act pursuant to
17Section 6 of Article XIII B of the California Constitution because
18the only costs that may be incurred by a local agency or school
19district will be incurred because this act creates a new crime or
20infraction, eliminates a crime or infraction, or changes the penalty
21for a crime or infraction, within the meaning of Section 17556 of
22the Government Code, or changes the definition of a crime within
23the meaning of Section 6 of Article XIII B of the California
24Constitution.
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