SB 172: Health care coverage: fertility preservation.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract to provide subscribers and enrollees all of the basic health care services, and defines basic health care services to include, among other things, physician services, hospital inpatient services and ambulatory care services, and preventive health services. Existing law requires an individual or small group health care service plan contract and health insurance policy issued, amended, or renewed on or after January 1, 2017, to include, at a minimum, coverage for essential health benefits, and defines essential health benefits to include, among other things, medically necessary basic health care services, as defined. Existing law requires every group health care service plan contract and health insurance policy that covers hospital, medical, or surgical expenses to offer coverage for the treatment of infertility, as defined, except in vitro fertilization.

This bill would expand the definition of basic health care services to include standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility. The bill would require an individual or group health care service plan contract or health insurance policy issued, amended, or renewed on and after January 1, 2018, that covers hospital, medical, surgical, and other iatrogenic expenses for diagnoses with medical interventions that may directly or indirectly cause iatrogenic infertility, or surgical expenses to include coverage for evaluation and treatment of iatrogenic infertility, as specified. standard fertility preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility. The bill would specify that it does not apply to a specialized health care service plan or a specialized health insurance policy. The bill would define terms for these purposes.

Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.