119-hr3480

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3480 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3480

 To amend the Patient Protection and Affordable Care Act to include 
 fertility treatment and care as an essential health benefit.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 May 19, 2025

Ms. Underwood introduced the following bill; which was referred to the 
 Committee on Energy and Commerce

_______________________________________________________________________

 A BILL

 To amend the Patient Protection and Affordable Care Act to include 
 fertility treatment and care as an essential health benefit.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Health Coverage for Inclusive and 
Valued Families Act of 2025'' or the ``Health Coverage for IVF Act of 
2025''.

SEC. 2. INCLUDING FERTILITY TREATMENT AND CARE AS AN ESSENTIAL HEALTH 
 BENEFIT.

    (a) In General.--

Section 1302

    (b) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022

    (b) ) is amended--

    (1) in paragraph

    (1) --
        (A) in the matter preceding subparagraph
        (A) , by 
 striking ``paragraph

    (2) '' and inserting ``paragraphs

    (2) and

    (6) ''; and
        (B) by adding at the end the following new 
 subparagraph:
 ``
        (K) Fertility treatment and care.''; and

    (2) by adding at the end the following new paragraph:
 ``

    (6) Fertility treatment and care defined.--For purposes 
 of paragraph

    (1)
        (K) , the term `fertility treatment and care' 
 means the following medically appropriate items and services 
 furnished to an individual:
 ``
        (A) Preservation of human oocytes, sperm, or 
 embryos for later reproductive use.
 ``
        (B) Artificial insemination, including 
 intravaginal insemination, intracervical insemination, 
 and intrauterine insemination.
 ``
            (C) Assisted reproductive technology, including 
 in vitro fertilization and other treatments or 
 procedures in which reproductive genetic material, such 
 as oocytes, sperm, fertilized eggs, and embryos, are 
 handled, when clinically appropriate, and including at 
 least 3 complete oocyte retrievals and an unlimited 
 number of embryo transfers from such retrievals 
 (regardless of whether such retrieval was performed on, 
 before, or after the date of the enactment of this 
 paragraph) in accordance with the guidelines of the 
 American Society for Reproductive Medicine and using 
 single embryo transfer when recommended and medically 
 appropriate.
 ``
            (D) Genetic testing of embryos.
 ``
        (E) Medications prescribed, as indicated for 
 fertility.
 ``
        (F) Gamete donation.
 ``
        (G) Such other information, referrals, 
 treatments, procedures, medications, laboratory 
 testing, technologies, and services relating to 
 fertility as the Secretary determines appropriate.''.

    (b) Additional Requirements.--Subpart II of part A of title XXVII 
of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is 
amended by adding at the end the following new section:

``

SEC. 2730. REQUIREMENTS RELATING TO FERTILITY TREATMENT AND CARE.

 ``

    (a) In General.--In the case of health insurance coverage offered 
in the individual or small group market that provides both medical and 
surgical benefits and benefits for fertility treatment and care (as 
defined in 

section 1302

    (b) of the Patient Protection and Affordable 
Care Act), such coverage shall ensure that--
 ``

    (1) the financial requirements applicable to such 
 fertility treatment and care benefits are no more restrictive 
 than the predominant financial requirements applied to 
 substantially all medical and surgical benefits covered by the 
 coverage, and there are no separate cost sharing requirements 
 that are applicable only with respect to fertility treatment 
 and care benefits; and
 ``

    (2) the treatment limitations applicable to such 
 fertility treatment and care benefits are no more restrictive 
 than the predominant treatment limitations applied to 
 substantially all medical and surgical benefits covered by the 
 coverage and there are no separate treatment limitations that 
 are applicable only with respect to fertility treatment and 
 care benefits.
 ``

    (b) Prohibition on Denial of Care.--A health insurance issuer 
offering health insurance coverage in the individual or small group 
market may not deny benefits for fertility treatment and care for 
individual on the basis that such individual lacks a diagnosis of 
infertility.
 ``
            (c) Utilization Management Tools.--
 ``

    (1) In general.--A health insurance issuer offering 
 health insurance coverage in the individual or small group 
 market that imposes any utilization management tool with 
 respect to fertility treatment and care shall, for each of the 
 first 5 plan years beginning on or after the date that is 1 
 year after the date of the enactment of this Act (and, upon 
 request of the Secretary or the Comptroller General of the 
 United States, for any subsequent plan year), conduct an 
 analysis of the application of any such tool to such treatment 
 and care and submit such analysis to the Secretary and to the 
 Comptroller General of the United States. Such analysis shall 
 contain the following information:
 ``
        (A) The specific coverage terms or other relevant 
 terms regarding the application of such tools to such 
 benefits and a description of all such benefits.
 ``
        (B) The factors used to determine when 
 utilization management tools apply to such benefits.
 ``
            (C) The evidentiary standards used in designing 
 the application of such tools with respect to such 
 benefits and any other source or evidence used to 
 determine the application of such tools to such 
 benefits.
 ``
            (D) Information demonstrating how application of 
 such tools to such benefits are consistent with 
 clinical guidelines for fertility treatment and care.
 ``
        (E) Any findings by the issuer that such coverage 
 is not in compliance with this section.
 ``

    (2) Report.--For plan years beginning on or after the 
 date that is 1 year after the date of the enactment of this 
 section, the Comptroller General of the United States shall 
 submit to Congress and make publicly available a report that 
 contains the following:
 ``
        (A) A summary of the analyses submitted under 
 paragraph

    (1) with respect to such plan year.
 ``
        (B) An identification of each health insurance 
 issuer that failed to submit an analysis under 
 paragraph

    (1) .
 ``
            (C) With respect to each health insurance issuer 
 that did submit such an analysis, a specification as to 
 whether such issuer submitted information sufficient to 
 determine whether such issuer was in compliance with 
 such requirements.
 ``
            (D) For each health insurance issuer that did 
 submit information sufficient to determine such 
 compliance, a finding of whether such issuer was in 
 compliance with such requirements.
 ``
            (d) === Definitions. ===
-The terms `financial requirement', 
`predominant', and `treatment limitation' have the meaning given such 
terms in 

section 2726

    (a)

    (3) .''.
            (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after the date that is 1 year after 
the date of the enactment of this Act.
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