HOPE with Fertility Services Act

Summary#

This bill would require employer group health plans and group health insurance that already cover obstetrical services to also cover infertility and iatrogenic infertility treatments. It defines "infertility" and "iatrogenic infertility" and lists treatments that must be covered, including in vitro fertilization, egg and sperm cryopreservation, intrauterine insemination, ovulation induction, and genetic testing. The bill allows standard fertility preservation when certain medical treatments (for example, surgery involving reproductive organs, radiation, chemotherapy, or myeloablative conditioning) cause or are expected to cause infertility.

The bill says coverage limits and cost-sharing (copays, coinsurance, deductibles, preauthorization) may apply but must not be more restrictive than the main medical and surgical benefits in the plan. Plans and issuers may not give incentives to discourage people from using these benefits, may not stop providers from discussing these treatments with patients, and may not reduce provider reimbursement for providing covered fertility services.

The bill requires plans that use utilization management tools on fertility benefits to perform and document analyses of those tools for the first five plan years after enactment and to submit the analyses to the federal Secretary. The Secretary can review, demand corrections, require plans to notify enrollees if a final noncompliance finding is made, and must report to Congress and the public about compliance beginning with plan years on or after January 1, 2027. Civil penalties of up to $100 per day per person are authorized for wrongful denials and for failing to submit required analyses. The section would take effect for plan years beginning on or after January 1, 2027.

What it means for you#

  • If your employer's group health plan covers obstetrical services, you would generally be entitled to coverage for infertility treatments and to fertility preservation when certain medical care risks causing infertility.
  • Covered treatments include assisted reproductive technologies like IVF, egg or sperm freezing, and other fertility services listed in the bill.
  • Plans can require usual cost-sharing and prior authorization, but those requirements cannot be more restrictive than the plan's typical medical and surgical rules.
  • Providers may discuss fertility treatment options with you, and plans cannot penalize providers for offering covered fertility services.
  • Plans must tell enrollees about these coverage rules starting in the second plan year after the law is enacted.

Expenses#

  • No publicly available information on estimated federal budgetary costs or effects on premiums is included in the bill text.
  • The bill sets civil penalty amounts in statute: up to $100 per day, per participant or beneficiary, for wrongful denial of required coverage (from denial until approval), and up to $100 per day for failing to submit required utilization management analyses after a corrective notice period.

Proponents' View#

No publicly available information on proponents' stated views or legislative findings is included in the bill text or the provided metadata.

Opponents' View#

No publicly available information on opponents' stated views or concerns is included in the bill text or the provided metadata.