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HARRY HUGHES, Governor 4091
INFERTILITY TREATMENTS FOR WHICH COVERAGE IS AVAILABLE UNDER THE
CONTRACT OR CERTIFICATION POLICY; AND
(5) (6) THE IN VITRO FERTILIZATION PROCEDURES ARE
PERFORMED AT MEDICAL FACILITIES THAT CONFORM TO THE AMERICAN
COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR IN VITRO
FERTILIZATION CLINICS OR TO THE AMERICAN FERTILITY SOCIETY
MINIMAL STANDARDS FOR PROGRAMS OF IN VITRO FERTILIZATION.
477CC.
EACH GROUP OR BLANKET HEALTH INSURANCE POLICY ISSUED OR
DELIVERED WITHIN THE STATE ON AN EXPENSE INCURRED BASIS AND WHICH
PROVIDES PREGNANCY-RELATED BENEFITS, SHALL INCLUDE MAY NOT
EXCLUDE BENEFITS FOR INPATIENT OR ALL OUTPATIENT EXPENSES ARISING
FROM IN VITRO FERTILIZATION PROCEDURES PERFORMED ON THE
CERTIFICATE HOLDER OR THE CERTIFICATE HOLDER'S DEPENDENT SPOUSE,
PROVIDED THAT:
(1) BENEFITS UNDER THIS SECTION SHALL BE PROVIDED TO
THE SAME EXTENT AS THE BENEFITS PROVIDED FOR OTHER
PREGNANCY-RELATED PROCEDURES;
(1) (2) THE PATIENT IS A SUBSCRIBER CERTIFICATE
HOLDER OR COVERED DEPENDENT OF THE SUBSCRIBER CERTIFICATE HOLDER;
(2) (3) THE PATIENT'S OOCYTES ARE FERTILIZED WITH THE
PATIENT'S SPOUSE'S SPERM;
(3)(4) (I) THE PATIENT AND THE PATIENT'S SPOUSE HAVE
A HISTORY OF INFERTILITY OF AT LEAST 5 YEARS' DURATION; OR
(II) THE INFERTILITY IS ASSOCIATED WITH ONE OR
MORE OF THE FOLLOWING MEDICAL CONDITIONS:
1. ENDOMETRIOSIS;
2. EXPOSURE IN UTERO TO
DIETHYLSTILBESTROL, COMMONLY KNOWN AS PES; OR
3. BLOCKAGE OF, OR SURGICAL REMOVAL OF,
ONE OR BOTH FALLOPIAN TUBES (LATERAL OR BILATERAL SALPHINGECTOMY
SALPINGECTOMY);
(4) (5) THE PATIENT HAS BEEN UNABLE TO ATTAIN A
SUCCESSFUL PREGNANCY THROUGH ANY LESS COSTLY APPLICABLE
INFERTILITY TREATMENTS FOR WHICH COVERAGE IS AVAILABLE UNDER THE
CONTRACT OR CERTIFICATION POLICY; AND
(5) (6) THE IN VITRO FERTILIZATION PROCEDURES ARE
PERFORMED AT MEDICAL FACILITIES THAT CONFORM TO THE AMERICAN
COLLEGE OF OBSTETRIC AND GYNECOLOGY GUIDELINES FOR IN VITRO
FERTILIZATION CLINICS OR TO THE AMERICAN FERTILITY SOCIETY
MINIMAL STANDARDS FOR PROGRAMS OF IN VITRO FERTILIZATION.
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