45NOTE:  As provided in LFC policy, this report is intended only for use by the standing finance committees of the legislature.  The Legislative Finance Committee does not assume responsibility for the accuracy of the information in this report when used for other purposes.

 

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F I S C A L   I M P A C T   R E P O R T

 

 

 

SPONSOR:

Park

 

DATE TYPED:

1/27/03

 

HB

45

 

SHORT TITLE:

Insurance Coverage for Infertility

 

SB

 

 

 

ANALYST:

Wilson

 

APPROPRIATION

 

Appropriation Contained

Estimated Additional Impact

Recurring

or Non-Rec

Fund

Affected

FY03

FY04

FY03

FY04

 

 

 

 

 

See Narrative

 

 

 

SOURCES OF INFORMATION

 

Responses Received From

 

Commission on the Status of Women (CSW)

Public Regulation Commission (PRC)

Human Services Department (HSD)

Retiree Health Care Authority (RHCA)

Public School Insurance Authority (PSIA)

General Services Department (GSD)

 

SUMMARY

 

     Synopsis of Bill

 

House Bill 45 requires individual or group health insurance policies, health care plans or certificates of health insurance that are delivered or issued for delivery in New Mexico that offer maternity benefits to offer coverage for infertility diagnosis and treatment.

 

HB 45 also mandates health insurance contracts to include coverage for childhood immunizations, minimum hospital stays for mastectomies and lymph node dissections, prescription contraceptive drugs or devices approved the food and drug administration and infertility diagnosis and treatment. 

 

     Significant Issues

 

The insurance industry generally opposes mandated coverages such as those contained in HB 45. They argue that the decision as to which benefits will be covered should be between the purchaser of health insurance and the company selling the coverage.  Unfortunately for an employee in a group, it is the employer who is making the decision and not the covered individuals.

 

There is also a distinction between coverage for a medical condition versus coverage for infertility diagnosis and treatment.  Health insurers generally cover the diagnosis and treatment of natural physical conditions causing infertility, except for the reversal of sterilization.  For instance, where an enrollee’s primary care physician in consultation with a health care plan determines that a service such as a Fallopian tube obstruction or a hormone deficiency (as opposed to hormonal manipulations or excess hormones to increase product of mature ova for fertilization) is medically necessary, then these services would be covered.  Likewise, health insurers provide coverage for infertility testing to diagnose the cause of infertility.  However, health insurance products currently may exclude coverage for certain services related to infertility diagnosis and treatment such as sperm donor harvesting, in-vitro fertilization, Famete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer ( ZIFT), or the reversal of voluntary sterilization.

 

FISCAL IMPLICATIONS

 

Many of the procedures related to infertility diagnosis and treatment are extremely expensive. In-vitro fertilization, for example costs more than $10,000 a procedure and a woman can undergo several unsuccessful procedures a year. Insurance premiums will certainly rise, but the industry is unable to quantify the amount.

 

The State of New Mexico pays the employers share for three major groups: active state employees, public school employees and retirees from the previous groups.  Although they will not be required to comply with the provisions of HB 45 because they are self-insured or are exempted by other statute, these plans have traditionally offered comparable coverage

 

ADMINISTRATIVE IMPLICATIONS

 

House Bill 45 requires the form filing unit of the PRC’s Insurance Division’s Life & Health Bureau to review and process amended filings by insurers requiring such coverage. Likewise, the Life & Health Bureau would have to ensure that the industry was aware of this new mandated benefit and ensure compliance therewith. Since the PRC is currently handling form filing and notification to the industry they can handle the provisions of HB 45 with existing staff.

 

POSSIBLE QUESTIONS

 

Should the State mandate extremely expensive infertility coverage which will benefit a very small number of individuals and force every other insured  person to pay higher premiums?  

 

DW/yr