HOUSE HEALTH AND HUMAN SERVICES COMMITTEE SUBSTITUTE FOR

HOUSE BILL 95

57th legislature - STATE OF NEW MEXICO - first session, 2025

 

 

 

 

 

 

 

AN ACT

RELATING TO INSURANCE; ENACTING NEW SECTIONS OF THE PUBLIC ASSISTANCE ACT, THE HEALTH CARE PURCHASING ACT AND THE NEW MEXICO INSURANCE CODE TO REQUIRE FERTILITY PRESERVATION SERVICES IN CERTAIN CASES.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation or storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. Group health coverage, including any form of self-insurance, that is offered, issued or renewed under the Health Care Purchasing Act shall include coverage for medically necessary expenses for fertility preservation services when treatment may directly or indirectly cause iatrogenic infertility as determined by the insured's health care provider.

          C. Group health coverage, including any form of self-insurance, that is offered, issued or renewed under the Health Care Purchasing Act shall not establish a separate deductible for fertility-related services or any other separate cost-sharing requirement, except that a plan may require cost sharing in amounts that are similar to and do not exceed those required by the plan for comparable medical services.

          D. Coverage shall be provided regardless of the

insured's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health

conditions; or

                (5) personal characteristics, including age,

sex, sexual orientation, marital status, gender or gender identity."

     SECTION 2. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION

SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation or storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. In accordance with federal law, the secretary shall adopt and promulgate rules that provide medical assistance coverage for medically necessary expenses for fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility as determined by the enrollee's health care provider.

          C. Medical assistance coverage provided pursuant to this section shall be provided regardless of the enrollee's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health conditions; or

                (5) personal characteristics, including age, sex, sexual orientation, marital status, gender or gender identity."

     SECTION 3. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation or storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall include coverage for medically necessary expenses for fertility preservation services when treatment may directly or indirectly cause iatrogenic infertility as determined by the insured's health care provider.

          C. An individual or group health insurance policy that is offered, issued or renewed in this state shall not establish a separate deductible for fertility-related services or any other separate cost-sharing requirement, except that a plan may require cost sharing in amounts that are similar to and do not exceed those required by the plan for comparable medical services.

          D. Coverage shall be provided regardless of the

insured's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health

conditions; or

                (5) personal characteristics, including age,

sex, sexual orientation, marital status, gender or gender identity."

     SECTION 4. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation or storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. A blanket or group health policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall include coverage for medically necessary expenses for fertility preservation services when treatment may directly or indirectly cause iatrogenic infertility as determined by the insured's health care provider.

          C. A blanket or group health policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall not establish a separate deductible for fertility-related services or any other separate cost-sharing requirement, except that a plan may require cost sharing in amounts that are similar to and do not exceed those required by the plan for comparable medical services.

          D. Coverage shall be provided regardless of the

insured's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health

conditions; or

                (5) personal characteristics, including age,

sex, sexual orientation, marital status, gender or gender identity."

     SECTION 5. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation and storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. An individual or group health maintenance organization contract that is offered, issued for delivery or renewed in this state shall include coverage for medically necessary expenses for fertility preservation services when treatment may directly or indirectly cause iatrogenic infertility as determined by the enrollee's health care provider.

          C. An individual or group health maintenance organization contract that is offered, issued or renewed in this state shall not establish a separate deductible for fertility-related services or any other separate cost-sharing requirement, except that a plan may require cost sharing in amounts that are similar to and do not exceed those required by the contract for comparable medical services.

          D. Coverage shall be provided regardless of the

enrollee's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health

conditions; or

                (5) personal characteristics, including age,

sex, sexual orientation, marital status, gender or gender identity."

     SECTION 6. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR FERTILITY PRESERVATION SERVICES.--

          A. As used in this section:

                (1) "fertility preservation" means the use of specific medical interventions, in accordance with clinical practice guidelines that are generally accepted by health care providers in relevant clinical specialties, including the medications and procedures needed for the procurement, cryopreservation and storage of sperm, oocytes, embryos or gonadal tissue; and

                (2) "iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment.

          B. An individual or group health plan or certificate of insurance that is delivered, issued for delivery or renewed in this state shall include coverage for medically necessary expenses for fertility preservation services when treatment may directly or indirectly cause iatrogenic infertility as determined by the subscriber's health care provider.

          C. An individual or group health plan or certificate of insurance that is offered, issued or renewed in this state shall not establish a separate deductible for fertility-related services or any other separate cost-sharing requirement, except that a plan may require cost sharing in amounts that are similar to and do not exceed those required by the contract for comparable medical services.

          D. Coverage shall be provided regardless of the

subscriber's:

                (1) expected length of life;

                (2) present or predicted disability;

                (3) degree of medical dependency;

                (4) perceived quality of life or other health

conditions; or

                (5) personal characteristics, including age,

sex, sexual orientation, marital status, gender or gender identity."

     SECTION 7. EFFECTIVE DATE.--The effective date of the provisions of this act is January 1, 2026.

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