[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4648 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4648
To require health insurance plans to provide coverage for fertility
treatment, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2025
Ms. DeLauro (for herself, Mr. Doggett, Ms. Schakowsky, and Mrs.
Foushee) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and Workforce, Oversight and Government
Reform, Armed Services, and Veterans' Affairs, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To require health insurance plans to provide coverage for fertility
treatment, and for other purposes.
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 ``Access to Fertility Treatment and
Care Act''.
SEC. 2. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
(a) In General.--
(1) PHSA.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following:
``SEC. 2799A-11. STANDARDS RELATING TO BENEFITS FOR FERTILITY
TREATMENT.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall provide
coverage for fertility treatment, if such plan or coverage provides
coverage for obstetrical services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary determines
appropriate.
``(c) Required Coverage.--A group health plan and a health
insurance issuer offering group or individual health insurance coverage
that includes coverage for obstetrical services shall provide coverage
for fertility treatment determined appropriate by the health care
provider, regardless of whether the participant, beneficiary, or
enrollee receiving such treatment has been diagnosed with infertility
as defined by the American Society for Reproductive Medicine, if the
treatment is performed at, or prescribed by, a medical facility that is
in compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment may not be
imposed with respect to the services required to be covered under
subsection (c) to the extent that such cost-sharing exceeds the cost-
sharing applied to other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant, beneficiary, or enrollee to encourage such
participant, beneficiary, or enrollee not to seek or obtain
fertility treatment to which such participant, beneficiary, or
enrollee is entitled under this section or to providers to
induce such providers not to provide medically appropriate
fertility treatments to participants, beneficiaries, or
enrollees;
``(2) prohibit a provider from discussing with a
participant, beneficiary, or enrollee fertility treatment
relating to this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant, beneficiary, or
enrollee in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964, title IX of the Education Amendments of
1972, the Age Discrimination Act of 1975, section 504 of the
Rehabilitation Act of 1973, or section 1557 of the Patient
Protection and Affordable Care Act, exclude any individual from
coverage in accordance with this section, or discriminate
against any individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant, beneficiary, or enrollee to undergo
fertility treatment.
``(g) Notice.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall provide
notice to each participant, beneficiary, and enrollee under such plan
or coverage regarding the coverage required by this section in
accordance with regulations promulgated by the Secretary. Such notice
shall be in writing and prominently positioned in any literature or
correspondence made available or distributed by the plan or issuer and
shall be transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant, beneficiary, or
enrollee following the effective date of such
regulations;
``(B) as part of any yearly informational packet
sent to the participant, beneficiary, or enrollee; or
``(C) January 1, 2027;
``(2) in the case of a participant, beneficiary, or
enrollee not enrolled in the plan or coverage on the date of
transmission under paragraph (1), upon initial enrollment of
such participant, beneficiary, or enrollee; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group or individual health insurance coverage from
negotiating the level and type of reimbursement with a provider for
care provided in accordance with this section.''.
(2) ERISA.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following:
``SEC. 726. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage shall provide coverage for
fertility treatment, if such plan or coverage provides coverage for
obstetrical services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary of Health and
Human Services determines appropriate.
``(c) Required Coverage.--A group health plan and a health
insurance issuer offering group health insurance coverage that includes
coverage for obstetrical services shall provide coverage for fertility
treatment determined appropriate by the health care provider,
regardless of whether the participant or beneficiary receiving such
treatment has been diagnosed with infertility as defined by the
American Society for Reproductive Medicine, if the treatment is
performed at, or prescribed by, a medical facility that is in
compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment may not be
imposed with respect to the services required to be covered under
subsection (c) to the extent that such cost-sharing exceeds the cost-
sharing applied to other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain fertility treatment to which
such participant or beneficiary is entitled under this section
or to providers to induce such providers not to provide
medically appropriate fertility treatments to participants or
beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary fertility treatment relating to this
section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant or beneficiary
in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo fertility
treatment.
``(g) Notice.--A group health plan and a health insurance issuer
offering group health insurance coverage shall provide notice to each
participant and beneficiary under such plan or coverage regarding the
coverage required by this section in accordance with regulations
promulgated by the Secretary. Such notice shall be in writing and
prominently positioned in any literature or correspondence made
available or distributed by the plan or issuer and shall be
transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant or beneficiary
following the effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan or coverage on the date of transmission
under paragraph (1), upon initial enrollment of such
participant or beneficiary; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 et seq.) is amended by
inserting after the item relating to section 725 the
following new item:
``Sec. 726. Standards relating to benefits for fertility treatment.''.
(3) IRC.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``SEC. 9826. STANDARDS RELATING TO BENEFITS FOR FERTILITY TREATMENT.
``(a) In General.--A group health plan shall provide coverage for
fertility treatment, if such plan provides coverage for obstetrical
services.
``(b) Definition.--In this section, the term `fertility treatment'
includes the following:
``(1) Preservation of human oocytes, sperm, or embryos.
``(2) Artificial insemination, including intravaginal
insemination, intracervical insemination, and intrauterine
insemination.
``(3) Assisted reproductive technology, including in vitro
fertilization and other treatments or procedures in which
reproductive genetic material, such as oocytes, sperm, and
embryos, are handled, when clinically appropriate.
``(4) Genetic testing of embryos.
``(5) Medications prescribed or obtained over-the-counter,
as indicated for fertility.
``(6) Gamete donation.
``(7) Such other information, referrals, treatments,
procedures, medications, laboratory testing, technologies, and
services relating to fertility as the Secretary of Health and
Human Services determines appropriate.
``(c) Required Coverage.--A group health plan that includes
coverage for obstetrical services shall provide coverage for fertility
treatment determined appropriate by the health care provider,
regardless of whether the participant or beneficiary receiving such
treatment has been diagnosed with infertility as defined by the
American Society for Reproductive Medicine, if the treatment is
performed at, or prescribed by, a medical facility that is in
compliance with relevant standards set by an appropriate Federal
agency.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for fertility treatment may not be
imposed with respect to the services required to be covered under
subsection (c) to the extent that such cost-sharing exceeds the cost-
sharing applied to other medical services under the group health plan
or health insurance coverage or such other limitations are different
from limitations imposed with respect to such medical services, except
where such limitation is more favorable with respect to fertility
treatment. The Secretary shall promulgate interim final regulations to
carry out this subsection, notwithstanding the notice and comment
requirements of section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain fertility treatment to which
such participant or beneficiary is entitled under this section
or to providers to induce such providers not to provide
medically appropriate fertility treatments to participants or
beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary fertility treatment relating to this
section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided
fertility treatment to a qualified participant or beneficiary
in accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo fertility
treatment.
``(g) Notice.--A group health plan shall provide notice to each
participant and beneficiary under such plan regarding the coverage
required by this section in accordance with regulations promulgated by
the Secretary. Such notice shall be in writing and prominently
positioned in any literature or correspondence made available or
distributed by the plan and shall be transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan to the participant or beneficiary following the
effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan on the date of transmission under
paragraph (1), upon initial enrollment of such participant or
beneficiary; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended by adding at the end the
following new item:
``Sec. 9826. Standards relating to benefits for fertility treatment.''.
(b) Conforming Amendments.--
(1) PHSA.--Section 2724(c) of the Public Health Service Act
(42 U.S.C. 300gg-23(c)) is amended by striking ``section 2704''
and inserting ``sections 2704 and 2799A-11''.
(2) ERISA.--Section 731(c) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191(c)) is amended by
striking ``section 711'' and inserting ``sections 711 and
726''.
(c) Effective Dates.--
(1) In general.--The amendments made by subsections (a) and
(b) shall apply for plan years beginning on or after the date
that is 6 months after the date of enactment of this Act.
(2) Collective bargaining exception.--
(A) In general.--In the case of a group health plan
maintained pursuant to one or more collective
bargaining agreements between employee representatives
and one or more employers ratified before the date of
enactment of this Act, the amendments made by
subsection (a) shall not apply to plan years beginning
before the later of--
(i) the date on which the last collective
bargaining agreements relating to the plan
terminates (determined without regard to any
extension thereof agreed to after the date of
enactment of this Act), or
(ii) the date occurring 6 months after the
date of the enactment of this Act.
(B) Clarification.--For purposes of subparagraph
(A), any plan amendment made pursuant to a collective
bargaining agreement relating to the plan which amends
the plan solely to conform to any requirement added by
subsection (a) shall not be treated as a termination of
such collective bargaining agreement.
SEC. 3. FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following:
``(q)(1) In this subsection, the term `fertility treatment' has the
meaning given the term in section 2799A-11(b) of the Public Health
Service Act.
``(2) A contract under this chapter shall provide, in a manner
consistent with section 2799A-11 of the Public Health Service Act,
coverage for fertility treatment, if that contract covers obstetrical
benefits.
``(3) Coverage for fertility treatment under a health benefits plan
described in section 8903 or 8903a may not be subject to any copayment
or deductible greater than the copayment or deductible, respectively,
applicable to obstetrical benefits under the plan.
``(4) Subsection (m)(1) shall not, with respect to a contract under
this chapter, prevent the inclusion of any terms that, under paragraph
(2) of this subsection, are required by reason of section 2799A-11 of
the Public Health Service Act.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to--
(1) any contract entered into or renewed for a contract
year beginning on or after the date that is 180 days after the
date of enactment of this Act; and
(2) any health benefits plan offered under a contract
described in paragraph (1).
SEC. 4. BENEFITS FOR FERTILITY TREATMENT UNDER THE TRICARE PROGRAM.
(a) In General.--Chapter 55 of title 10, United States Code, is
amended by adding at the end the following new section:
``Sec. 1110c. Obstetrical and fertility benefits
``(a) In General.--Any health care plan under this chapter shall
provide, in a manner consistent with section 2799A-11 of the Public
Health Service Act, coverage for fertility treatment, if such plan
covers obstetrical benefits.
``(b) Copayment.--The Secretary of Defense shall establish cost-
sharing requirements for the coverage of fertility treatment that are
consistent with the cost-sharing requirements applicable to health
plans and health insurance coverage under section 2799A-11(d) of the
Public Health Service Act.
``(c) Regulations.--The Secretary of Defense shall prescribe any
regulations necessary to carry out this section.
``(d) Definitions.--In this section, the term `fertility treatment'
has the meaning given the term in section 2799A-11(b) of the Public
Health Service Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 55 of such title is amended by adding at the end the following
new item:
``1110c. Obstetrical and fertility benefits.''.
SEC. 5. FERTILITY TREATMENT FOR VETERANS AND SPOUSES OR PARTNERS OF
VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720M. Fertility treatment for veterans and spouses or partners
of veterans
``(a) In General.--The Secretary shall furnish fertility treatment
services to a veteran or a spouse or partner of a veteran if the
veteran, and the spouse or partner of the veteran, as applicable, apply
jointly for such fertility treatment through a process prescribed by
the Secretary for purposes of this section.
``(b) Definitions.--In this section, the term `fertility treatment'
has the meaning given the term in section 2799A-11(b) of the Public
Health Service Act.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1720L the following new item:
``1720M. Fertility treatment for veterans and spouses or partners of
veterans.''.
(c) Regulations.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe regulations to carry out section 1720M of title 38, United
States Code, as added by subsection (a).
SEC. 6. REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE MEDICAL
ASSISTANCE FOR FERTILITY TREATMENT.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(4)(C), by inserting ``(which shall
include fertility treatment provided in accordance with
subsection (kk))'' after ``family planning services and
supplies''; and
(2) by adding at the end the following new subsection:
``(kk) Requirements for Coverage of Fertility Treatment.--For
purposes of subsection (a)(4)(C), a State shall ensure that the medical
assistance provided under the State plan (or waiver of such plan) for
fertility treatment complies with the requirements of section 2799A-
11(b) of the Public Health Service Act in the same manner as such
requirements and limitations apply to health insurance coverage offered
by a group health plan or health insurance issuer.''.
(b) Technical Amendment.--Section 1903(a)(5) of the Social Security
Act (42 U.S.C. 1396b(a)(5)) is amended by inserting ``described in
section 1905(a)(4)(C)'' after ``family planning services and
supplies''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on October 1,
2026.
(2) Delay permitted if state legislation required.--In the
case of a State plan approved under title XIX of the Social
Security Act which the Secretary of Health and Human Services
determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirement imposed by this section, the State plan
shall not be regarded as failing to comply with the
requirements of such title solely on the basis of the failure
of the plan to meet such additional requirement before the
first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that ends after the 1-year period beginning with the date of
the enactment of this section. For purposes of the preceding
sentence, in the case of a State that has a 2-year legislative
session, each year of the session is deemed to be a separate
regular session of the State legislature.
SEC. 7. MEDICARE COVERAGE OF FERTILITY TREATMENT.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (JJ), by inserting ``and'' after the
semicolon at the end; and
(2) by adding at the end the following new subparagraph:
``(KK) fertility treatment (as defined in section 2799A-
11(b) of the Public Health Service Act);''.
(b) Payment and Waiver of Coinsurance.--Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and'' before ``(HH)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (II) with respect to fertility treatment (as
described in section 1861(s)(2)(KK)), the amount paid shall be
equal to 100 percent of the lesser of the actual charge for the
treatment or the amount determined under the payment basis
determined under section 1848''.
(c) Waiver of Application of Deductible.--The first sentence of
section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is
amended--
(1) by striking ``, and (13)'' and inserting ``(13)''; and
(2) by striking ``1861(n)..'' and inserting ``1861(n), and
(14) such deductible shall not apply with respect to fertility
treatment (as described in section 1861(s)(2)(KK)).''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by
inserting ``(2)(KK),'' after ``risk assessment),''.
(e) Conforming Amendment Regarding Coverage.--Section 1862(a)(1)(A)
of the Social Security Act (42 U.S.C. 1395y(a)(1)(A)) is amended--
(1) by striking ``or additional'' and inserting ``,
additional''; and
(2) by inserting ``, or fertility treatment (as described
in section 1861(s)(2)(KK))'' after ``1861(ddd)(1))''.
(f) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2026.
<all>