PRINTER'S NO. 2182
No. 352 Session of 2005
INTRODUCED BY BUNT, JUNE 14, 2005
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JUNE 14, 2005
A RESOLUTION 1 Directing the Pennsylvania Health Care Cost Containment Council 2 to conduct a study concerning the requirement of 3 comprehensive insurance coverage for the diagnosis and 4 treatment of infertility. 5 WHEREAS, The commonly accepted definition of infertility is 6 12 months or more of unprotected intercourse without pregnancy 7 for a woman under 35 years of age or six months for a woman 35 8 years of age or older; and 9 WHEREAS, There is an effective and established continuum of 10 care for treating infertility through assisted reproductive 11 technology; and 12 WHEREAS, Most insurance plans already provide some 13 infertility coverage through major medical benefits and 14 pregnancy or maternity benefits; and 15 WHEREAS, Many couples facing infertility today are compelled 16 to choose treatment within the parameters of their insurance 17 coverage rather than what is medically less invasive, less 18 costly, less risky, more effective and therefore more
1 appropriate; and 2 WHEREAS, Employers would rather spend their insurance 3 premiums on equally or less costly, more effective fertility 4 care occurring over a shorter period of time than now required; 5 and 6 WHEREAS, It is well documented that states requiring health 7 insurance for assisted reproductive technologies have a far 8 lower incidence of multiple births (twins, triplets or higher) 9 than other states; and 10 WHEREAS, Reducing the incidence of multiple births from 11 better use of and improved access to the full continuum of 12 assisted reproductive technologies will reduce current insurance 13 expenditures; and 14 WHEREAS, A reduction in the number of multiple births 15 constitutes a significant improvement in infertility treatment 16 overall, resulting in less risk to mother and child, less costly 17 prenatal and delivery care and reduced time in and expenditures 18 borne by insurers for neonatal intensive care; and 19 WHEREAS, Pennsylvania needs to improve access to 20 comprehensive infertility treatment that is already available to 21 State employees and to some municipal employees and to residents 22 in Maryland, Massachusetts, New Jersey, New York, Ohio and West 23 Virginia; and 24 WHEREAS, Lack of comprehensive infertility coverage places 25 Pennsylvania industry in a less competitive position with 26 respect to access among similar industries in surrounding 27 states; and 28 WHEREAS, To deny potentially successful treatment of the 29 disease of infertility is wrong, especially since it has been 30 demonstrated that the cost of requiring comprehensive 20050H0352R2182 - 2 -
1 infertility coverage is minimal, cost-neutral or possibly a 2 savings over treatments now commonly covered; and 3 WHEREAS, Infertility impacts a couple's general health, their 4 marriage, job performance and social interactions; and 5 WHEREAS, There is compelling actuarial data revealing that 6 the cost of infertility treatment adds little, if anything, to 7 the cost of insurance premiums and indeed might reduce costs by 8 limiting performance of less-effective treatments commonly 9 covered by insurance today; and 10 WHEREAS, Bargaining power on the part of the insurer will 11 further help drive down procedure and material costs for 12 treatment; therefore be it 13 RESOLVED, That the House of Representatives direct the 14 Pennsylvania Health Care Cost Containment Council to conduct a 15 study concerning the requirement of comprehensive insurance 16 coverage for the diagnosis and treatment of infertility 17 consistent with the following restrictions: 18 (1) Exclusion of elective sterilization reversal or use 19 of assisted reproductive technology when infertility is the 20 result of elective sterilization. 21 (2) Exclusion of services provided in connection with 22 the use of a surrogate gestational mother. 23 (3) Requiring waiting periods before assisted 24 reproductive technology may be employed, consistent with 25 recommended treatment guidelines issued by the American 26 Society for Reproductive Medicine (ASRM), the Society for 27 Reproductive Endocrinologists and Infertility (SREI) or the 28 American College of Obstetricians and Gynecologists (ACOG). 29 (4) Requiring the use of assisted reproductive 30 technology procedures to follow the recommended treatment 20050H0352R2182 - 3 -
1 guidelines issued by the ASRM, SREI or ACOG. 2 (5) Exclusion of coverage for women under 21 years of 3 age or over 45 years of age. 4 (6) Limiting coverage for assisted reproductive 5 technology to the policyholder and spouse or both. 6 (7) Requiring that in vitro fertilization (IVF), gamete 7 intrafallopian transfer (GIFT) or zygote intrafallopian 8 transfer (ZIFT) be performed at a reproductive health clinic 9 reporting annually to the Centers for Disease Control and 10 Prevention. 11 (8) Limiting coverage to four IVF, GIFT or ZIFT 12 procedures per live birth, with a maximum of eight cycles per 13 subscriber per lifetime. 14 (9) Excluding coverage for techniques or procedures 15 deemed experimental and/or investigational by the ASRM, SREI 16 or the ACOG. 17 (10) Requiring copayment or deductibles for assisted 18 reproductive technology procedures, which shall not exceed 19 those for all other pregnancy-related benefits, up to a 20 maximum of 20% of the cost of the procedure; 21 and be it further 22 RESOLVED, That the Pennsylvania Health Care Cost Containment 23 Council report its findings to the General Assembly by December 24 31, 2005. E27L82JAM/20050H0352R2182 - 4 -