AB286: Bill Text

AB286, s. 13 Section 13. 619.14 (4) (n) of the statutes is created to read:

AB286,4,25 619.14 (4) (n) Any charge for performing a procedure for the diagnosis or treatment of infertility.

AB286, s. 14 Section 14. 632.893 of the statutes is created to read:

AB286,5,3 632.893 Required coverage of diagnosis and treatment of infertility. (1) Definitions. In this section:

AB286,5,4 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

AB286,5,7 (b) "Gamete intrafallopian tube transfer" means a procedure in which a mixture containing both egg and sperm is directly transferred to the fallopian tube, where fertilization occurs.

AB286,5,10 (c) "Infertility" means the inability to conceive or produce conception after engaging in unprotected sexual intercourse over a period of at least one year, or the inability to carry a pregnancy to live birth.

AB286,5,13 (d) "In vitro fertilization" means a procedure in which an egg and sperm are combined in a laboratory dish, where fertilization occurs, and the fertilized and dividing egg is transferred to the uterus or cryopreserved for future use.

AB286,5,16 (e) "Nonexperimental procedure" means a clinical procedure that is recognized as safe and effective by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

AB286,5,20 (f) "Zygote intrafallopian tube transfer" means a procedure in which an egg and sperm are combined in a laboratory dish, where fertilization occurs, and the fertilized egg is transferred to the fallopian tube at the pronuclear stage before cell division takes place.

AB286,5,25 (2) Required coverage. Except as provided in subs. (3) and (5) and s. 49.45 (20m), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides maternity coverage shall provide coverage of any nonexperimental procedure for the diagnosis and treatment of infertility.

AB286,6,3 (3) Conditional requirements for certain procedures. The coverage requirement under sub. (2) applies to in vitro fertilization, gamete intrafallopian tube transfer or zygote intrafallopian tube transfer only if all of the following apply:

AB286,6,6 (a) The covered individual has tried other less costly and medically appropriate nonexperimental procedures for the treatment of infertility and has been unable to carry a pregnancy to live birth.

AB286,6,8 (b) The covered individual has undergone fewer than 4 completed oocyte retrievals at any time in connection with any infertility procedure or procedures.

AB286,6,11 (c) The covered individual has undergone fewer than 2 completed oocyte retrievals at any time in connection with any infertility procedure or procedures after a live birth following a completed oocyte retrieval.

AB286,6,15 (d) The procedure is performed at a medical facility that conforms to the standards and guidelines of the American Association of Tissue Banks and of either the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

AB286,6,18 (4) Copayments and deductibles. The coverage required under this section may not be subject to copayments or deductibles that are greater than any copayments or deductibles that apply to maternity coverage under the policy or plan.

AB286,6,19 (5) Exclusion. This section does not apply to any of the following:

AB286,6,21 (a) A medicare replacement policy, a medicare supplement policy or a long-term care insurance policy.

AB286,6,22 (b) A limited service health organization, as defined in s. 609.01 (3).

AB286,6,25 (c) The mandatory health insurance risk-sharing plan under ch. 619 and any alternative plans offered under s. 619.145 to persons eligible for coverage under s. 619.12.

AB286, s. 15 Section 15. Initial applicability.

AB286,7,2 (1) This act first applies to all of the following:

AB286,7,5 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies that are issued or renewed, and self-insured health plans that are established, extended, modified or renewed, on the effective date of this paragraph.

AB286,7,8 (b) Disability insurance policies covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

AB286,7,9 1. The day on which the collective bargaining agreement expires.

AB286,7,11 2. The day on which the collective bargaining agreement is extended, modified or renewed.

AB286,7,14 (c) Self-insured health plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified or renewed on the earlier of the following:

AB286,7,15 1. The day on which the collective bargaining agreement expires.

AB286,7,17 2. The day on which the collective bargaining agreement is extended, modified or renewed.

AB286, s. 16 Section 16. Effective date.

AB286,7,20 (1) This act takes effect on the first day of the 5th month beginning after publication.

AB286,7,21 (End)