PocketLaw | Utah Code | Expanded infertility treatment coverage pilot

Expanded infertility treatment coverage pilot program.

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Affected by 63I-1-249 on 1/1/2025

Effective 5/5/2021
49-20-418. Expanded infertility treatment coverage pilot program.

(1) As used in this section:
- (a) "Assisted reproductive technology" means the same as the term is defined in 42 U.S.C. Sec. 263a-7.
- (b) "Physician" means the same as the term is defined in Section 58-67-102.
- (c) "Pilot program" means the expanded infertility treatment coverage pilot program described in Subsection (2).
- (d) "Qualified assisted reproductive technology cycle" means the use of assisted reproductive technology to transfer a single embryo for implantation.
- (e) "Qualified individual" means a covered individual who is eligible for maternity benefits under the program.

(2)
- (a) Beginning plan year 2018-19, and ending plan year 2023-24, the program shall offer a pilot program within the state risk pool that provides coverage to a qualified individual for the use of an assisted reproductive technology.
- (b)
  - (i) For plan year 2018-19, 2019-20, or 2020-21, the pilot program shall offer a one-time benefit of $4,000 toward the costs of using an assisted reproductive technology for each qualified individual.
  - (ii) For plan year 2021-22, 2022-23, or 2023-24, the pilot program shall offer a benefit of $4,000 to a qualified individual toward the costs of each qualified assisted reproductive technology cycle.
- (c) The benefits described in Subsection (2)(b) are subject to the same cost sharing requirements as the covered individual's plan.

(3) Coverage offered under the pilot program applies if:
- (a) the patient who will use the assisted reproductive technology is a qualified individual;
- (b)
  - (i) the patient's physician verifies that the patient or the patient's spouse has a demonstrated condition recognized by a physician as a cause of infertility; or
  - (ii) the patient attests that the patient is unable to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations without contraception;
- (c) the patient attests that the patient has been unable to attain a successful pregnancy through any less-costly, potentially effective infertility treatments for which coverage is available under the health benefit plan; and
- (d) the use of the assisted reproductive technology procedure is performed at a medical facility that conforms to the minimal standards for programs of assisted reproductive technology procedures adopted by the American Society for Reproductive Medicine.

(4) Coverage offered under the pilot program:
- (a) shall satisfy, in accordance with Subsection 31A-22-610.1(1)(c)(ii), the requirement to provide an adoption indemnity benefit to a qualified individual under Section 31A-22-610.1;
- (b) does not apply to a qualified individual if the qualified individual has received the adoption indemnity benefit required under Section 31A-22-610.1; and
- (c) for plan year 2021-22, 2022-23, or 2023-24, shall apply to a qualified individual, even if the qualified individual received the benefit described in Subsection (2)(b)(i).

(5)
- (a) The purpose of the pilot program is to study the efficacy of providing coverage for the use of an assisted reproductive technology and is not a mandate for coverage of an assisted reproductive technology within all health plans offered by the program.
- (b) The program shall report to the Retirement and Independent Entities Interim Committee regarding the costs and benefits of the pilot program:
  - (i) on or before October 1; and
  - (ii) during calendar years 2022 and 2023.

(6) Under Section 63J-1-603, the Legislature intends that the cost of the pilot program will be paid from money above the minimum recommended level in the public employees' state risk pool reserve.

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