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SB-172 Health care coverage: fertility preservation.(2017-2018)

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Date Published: 03/07/2017 09:00 PM
SB172:v98#DOCUMENT

Amended  IN  Senate  March 07, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 172


Introduced by Senator Portantino

January 23, 2017


An act to add Section 1374.551 to the Health and Safety Code, and to add Section 10119.61 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 172, as amended, Portantino. 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. Existing law requires every group health care service plan contract and health insurance policy that covers hospital, medical, or surgical expenses to offer coverage for the treatment of infertility, as defined, except in vitro fertilization.
This bill would require an individual or group health care service plan contract or health insurance policy issued, amended, or renewed on and after January 1, 2018, that covers hospital, medical, or surgical expenses surgical, and other iatrogenic expenses for diagnoses with medical interventions that may directly or indirectly cause iatrogenic infertility, to include 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. evaluation and treatment of iatrogenic infertility, as specified. The bill would specify that it does not apply to a specialized health care service plan or a specialized health insurance policy.
Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose 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   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1374.551 is added to the Health and Safety Code, to read:

1374.551.
 (a) An individual or group health care service plan contract issued, amended, or renewed on and after January 1, 2018, that covers hospital, medical, or surgical expenses shall include coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment surgical, and other iatrogenic expenses for diagnoses with medical interventions that may directly or indirectly cause iatrogenic infertility to an enrollee. shall include coverage for evaluation and treatment of iatrogenic infertility including, but not limited to, standard fertility preservation services.
(b) For purposes of this section, the following terms have the following meanings:
(1) “Iatrogenic” means relating to illness caused by medical examination or treatment.
(2) “Iatrogenic infertility” means infertility caused by a medical intervention, including, but not limited to, reactions from prescribed drugs or from medical and surgical procedures.
(3) “Infertility” means the result of a disease, an interruption, cessation, or disorder of body functions, systems, or organs, of the male or female reproductive tract that prevents the conception of a child or the ability to carry a pregnancy to delivery.
(4) “May directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organization.
(5) “Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organization.
(c) This section does not apply to a specialized health care service plan.

SEC. 2.

 Section 10119.61 is added to the Insurance Code, to read:

10119.61.
 (a) An individual or group health insurance policy issued, amended, or renewed on and after January 1, 2018, that covers hospital, medical, or surgical expenses shall include coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment surgical, and other iatrogenic expenses for diagnoses with medical interventions that may directly or indirectly cause iatrogenic infertility to an insured. shall include coverage for evaluation and treatment of iatrogenic infertility including, but not limited to, standard fertility preservation services.
(b) For purposes of this section, the following terms have the following meanings:
(1) “Iatrogenic” means relating to illness caused by medical examination or treatment.
(2) “Iatrogenic infertility” means infertility caused by a medical intervention, including, but not limited to, reactions from prescribed drugs or from medical and surgical procedures.
(3) “Infertility” means the result of a disease, an interruption, cessation, or disorder of body functions, systems, or organs, of the male or female reproductive tract that prevents the conception of a child or the ability to carry a pregnancy to delivery.
(4) “May directly or indirectly cause” means treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional organization.
(5) “Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organization.
(c) This section does not apply to a specialized health insurance policy.

SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.