H.R. 3480
119th CONGRESS 1st Session
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 · Sponsor: Ms. Underwood · Committee: Committee on Energy and Commerce
Table of contents
SEC. 1. Short title
- This Act may be cited as the or the .
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 () is amended— 42 U.S.C. 18022(b)
- in paragraph (1)—
- in the matter preceding subparagraph (A), by striking
paragraph (2)and insertingparagraphs (2) and (6); and- Fertility treatment and care.
- by adding at the end the following new subparagraph:
- (6) Fertility treatment and care defined
- For purposes of paragraph (1)(K), the term means the following medically appropriate items and services furnished to an individual:
fertility treatment and care- Preservation of human oocytes, sperm, or embryos for later reproductive use.
- Artificial insemination, including intravaginal insemination, intracervical insemination, and intrauterine insemination.
- 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.
- Genetic testing of embryos.
- Medications prescribed, as indicated for fertility.
- Gamete donation.
- Such other information, referrals, treatments, procedures, medications, laboratory testing, technologies, and services relating to fertility as the Secretary determines appropriate.
- For purposes of paragraph (1)(K), the term means the following medically appropriate items and services furnished to an individual:
- in the matter preceding subparagraph (A), by striking
- by adding at the end the following new paragraph:
- in paragraph (1)—
- Section 1302(b) of the Patient Protection and Affordable Care Act () is amended— 42 U.S.C. 18022(b)
- (b) Additional requirements
- Subpart II of part A of title XXVII of the Public Health Service Act () is amended by adding at the end the following new section: 42 U.S.C. 300gg–11 et seq.
- (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—
- 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
- 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.
- 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—
- (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:
- The specific coverage terms or other relevant terms regarding the application of such tools to such benefits and a description of all such benefits.
- The factors used to determine when utilization management tools apply to such benefits.
- 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.
- Information demonstrating how application of such tools to such benefits are consistent with clinical guidelines for fertility treatment and care.
- Any findings by the issuer that such coverage is not in compliance with this section.
- 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:
- (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 summary of the analyses submitted under paragraph (1) with respect to such plan year.
- An identification of each health insurance issuer that failed to submit an analysis under paragraph (1).
- 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.
- 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.
- 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:
- (1) In general
- (d) Definitions
- The terms , , and have the meaning given such terms in section 2726(a)(3).
financial requirementpredominanttreatment limitation
- The terms , , and have the meaning given such terms in section 2726(a)(3).
- (a) In general
- Subpart II of part A of title XXVII of the Public Health Service Act () is amended by adding at the end the following new section: 42 U.S.C. 300gg–11 et seq.
- (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.