RSA 417-G:3 · Prohibited and Permissible Limitations on Coverage

417-G:3 Prohibited and Permissible Limitations on Coverage. –

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I.

No health carrier shall:

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(a)

Impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage for required benefits which are different from those imposed upon benefits for services not related to infertility or any limitations on coverage of fertility medications that are different from those imposed on any other prescription medications.

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(b)

Impose pre-existing condition exclusions or pre-existing condition waiting periods on coverage for required benefits or use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting or otherwise restricting the availability of coverage for required benefits.

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(c)

Impose limitations on coverage based solely on arbitrary factors including, but not limited to, number of attempts or dollar amounts or age, or provide different benefits to, or impose different requirements upon, a class protected under RSA 354-A than that provided to, or required of, other patients.

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II.

Limitations on coverage shall be based on clinical guidelines and the enrollee's medical history. Clinical guidelines shall be maintained in written form and shall be available to any enrollee upon request. Standards or guidelines developed by the American Society for Reproductive Medicine, the American College of Obstetrics and Gynecology, or the Society for Assisted Reproductive Technology may serve as a basis for these clinical guidelines. Making, issuing, circulating, or causing to be made, issued or circulated, any clinical guidelines that are based upon data that are not reasonably current or that do not cite with specificity any references relied upon shall constitute an unfair and deceptive act and practice in the business of insurance under RSA 417:4.

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III.

This chapter shall not be construed to provide benefits for:

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(a)

An experimental infertility procedure.

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(b)

Non-medical costs related to third party reproduction.

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(c)

Reversal of voluntary sterilization.

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IV.

In instances where an enrollee is utilizing a surrogate or gestational carrier due to a medical cause of infertility unrelated to voluntary sterilization or failed reversal, the enrollee's coverage shall not extend to medical costs relating to the preparation for reception or introduction of embryos, oocytes, or donor sperm into a surrogate or gestational carrier. Source. 2019, 307:2, eff. Jan. 1, 2020.

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