SB693,1,3 1An Act to create 609.74 and 632.895 (15m) of the statutes; relating to: coverage
2of infertility services under health policies and plans and granting
3rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies and self-insured governmental
health plans that cover medical or hospital expenses to cover diagnosis of and
treatment for infertility and standard fertility preservation services. Coverage
required under the bill must include at least four completed egg retrievals with
unlimited embryo transfers in accordance with certain guidelines and single embryo
transfer is allowed when recommended and medically appropriate. Policies and
plans are prohibited from imposing an exclusion, limitation, or other restriction on
coverage of medications of which the bill requires coverage that is not imposed on any
other prescription medications covered under the policy or plan. Similarly, policies
and plans may not impose any exclusion, limitation, cost-sharing requirement,
benefit maximum, waiting period or other restriction on diagnosis, treatment, or
services for which coverage is required under the bill that is different from any
exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period
or other restriction imposed on benefits for other services. Also, policies and plans
may not impose an exclusion, limitation, or other restriction on diagnosis, treatment,
or services for which coverage is required under the bill on the basis that an insured
person participates in fertility services provided by or to a third party. Current law
refers to health insurance policies as disability insurance policies.

This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB693,1 1Section 1. 609.74 of the statutes is created to read:
SB693,2,3 2609.74 Coverage of infertility services. Defined network plans and
3preferred provider plans are subject to s. 632.895 (15m).
SB693,2 4Section 2. 632.895 (15m) of the statutes is created to read:
SB693,2,55 632.895 (15m) Coverage of infertility services. (a) In this subsection:
SB693,2,116 1. “Diagnosis of and treatment for infertility” means any recommended
7procedure or medication at the direction of a physician that is consistent with
8established, published, or approved medical practices or professional guidelines
9from the American College of Obstetricians and Gynecologists, or its successor
10organization, or the American Society for Reproductive Medicine, or its successor
11organization.
SB693,2,1312 2. “Infertility” means a disease, condition, or status characterized by any of the
13following:
SB693,2,1814 a. The failure to establish a pregnancy or carry a pregnancy to a live birth after
15regular, unprotected sexual intercourse for, if the woman is under the age of 35, no
16longer than 12 months or, if the woman is 35 years of age or older, no longer than 6
17months including any time during those 12 months or 6 months that the woman has
18a pregnancy that results in a miscarriage.
SB693,2,2019 b. An individual's inability to reproduce either as a single individual or with
20a partner without medical intervention.
SB693,3,2
1c. A physician's findings based on a patient's medical, sexual, and reproductive
2history, age, physical findings, or diagnostic testing.
SB693,3,43 3. “Self-insured health plan" means a self-insured health plan of the state or
4a county, city, village, town, or school district.
SB693,3,115 4. “Standard fertility preservation service” means a procedure that is
6consistent with established medical practices or professional guidelines published
7by the American Society for Reproductive Medicine, or its successor organization, or
8the American Society of Clinical Oncology, or its successor organization, for a person
9who has a medical condition or is expected to undergo medication therapy, surgery,
10radiation, chemotherapy, or other medical treatment that is recognized by medical
11professionals to cause a risk of impairment to fertility.
SB693,3,1812 (b) Subject to pars. (c) to (e), every disability insurance policy and self-insured
13health plan that provides coverage for medical or hospital expenses shall cover
14diagnosis of and treatment for infertility and standard fertility preservation
15services. Coverage required under this paragraph includes at least 4 completed
16oocyte retrievals with unlimited embryo transfers in accordance with the guidelines
17of the American Society for Reproductive Medicine or its successor organization and
18single embryo transfer may be used when recommended and medically appropriate.
SB693,3,2019 (c) 1. A disability insurance policy or self-insured health plan may not do any
20of the following:
SB693,3,2321 a. Impose any exclusions, limitations, or other restrictions on coverage
22required under par. (b) based on a covered individual's participation in fertility
23services provided by or to a 3rd party.
SB693,4,224 b. Impose any exclusion, limitation, or other restriction on coverage of
25medications that are required to be covered under par. (b) that are different from

1those imposed on any other prescription medications covered under the policy or
2plan.
SB693,4,83 c. Impose any exclusion, limitation, cost sharing requirement, benefit
4maximum, waiting period or other restriction on coverage that is required under par.
5(b) of diagnosis of and treatment for infertility and standard fertility preservation
6services that is different from an exclusion, limitation, cost-sharing requirement,
7benefit maximum, waiting period or other restriction imposed on benefits for
8services that are covered by the policy or plan and that are not related to infertility.
SB693,4,129 2. A disability insurance policy or self-insured health plan shall provide
10coverage required under par. (b) to any covered individual under the policy or plan,
11including any covered spouse and nonspouse dependent, to the same extent as other
12pregnancy-related benefits covered under the policy or plan.
SB693,4,1813 (d) The commissioner, after consulting with the department of health services
14on appropriate treatment for infertility, shall promulgate any rules necessary to
15implement this subsection. Before the promulgation of rules, disability insurance
16policies and self-insured health plans are considered to comply with the coverage
17requirements of par. (b) if the coverage conforms to the standards of the American
18Society for Reproductive Medicine.
SB693,4,2019 (e) This subsection does not apply to a disability insurance policy that is a
20health benefit plan described under s. 632.745 (11) (b).
SB693,3 21Section 3. Initial applicability.
SB693,4,2422 (1) For policies and plans containing provisions inconsistent with this act, the
23act first applies to policy or plan years beginning on the effective date of this
24subsection, except as provided in sub. (2 ).
SB693,5,5
1(2) For policies and plans that are affected by a collective bargaining agreement
2containing provisions inconsistent with this act, this act first applies to policy or plan
3years beginning on the effective date of this subsection or on the day on which the
4collective bargaining agreement is newly established, extended, modified, or
5renewed, whichever is later.
SB693,5,66 (End)
Loading...
Loading...