Bill
SB 2460
Rhode Island will require insurance plans to cover medically necessary infertility diagnosis, treatment, and standard fertility preservation for women 25–42, with parity and limits
Purpose and intent
- SB 2460 amends Rhode Island law to require as a standard benefit the coverage of infertility diagnosis and treatment, including standard fertility-preservation services, when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
- The bill applies to various types of health insurance offerings (group/band policies) by insurers operating in Rhode Island, with a stated effective date of January 1, 2027.
Key provisions and changes
1) Coverage scope for infertility
- Applies to: Blanket or group policies delivered in Rhode Island that include pregnancy-related benefits.
- Populations covered: Women aged 25 to 42.
- Services covered:
- Diagnosis and treatment of infertility that is medically necessary.
- Standard fertility-preservation services (e.g., procedures, counseling, medications, and the storage/preservation of gametes/embryos).
- Treatment must be covered when a medical treatment may directly or indirectly cause infertility (iatrogenic infertility).
2) Infertility definitions and criteria
- Infertility defined as:
- Conditions impacting the ability to conceive or carry to live birth, as determined by a healthcare provider, including infertility related to disability or medical treatments/conditions.
- Time-based criteria (12 months of unprotected intercourse with necessary gametes; or 6 months if age-related considerations apply; also includes cases where necessary gametes are lacking).
- Additional factors may include age-related failure to conceive, genetic/genomic risks, or definitions per standard medical guidelines (e.g., ASRM, ASCO).
3) Fertility-preservation services
- Standard fertility-preservation services include procedures to preserve fertility (procurement, cryopreservation, storage of gametes/embryos) as part of medical care that may impair fertility.
4) Insurance parity and protections
- Prohibits discrimination in coverage for infertility on age, ancestry, disability, gender identity, race, religion, sexual orientation, etc.
- Prohibits various barriers that often limit infertility coverage:
- No pre-existing condition exclusions or waiting periods for infertility benefits.
- No limits based on arbitrary factors (e.g., number of attempts, dollar amounts, age).
- No differential treatment for donor gametes/embryos or surrogacy.
- Fertility medications coverage is treated comparably to other prescription meds.
- Coverage must allow for infertility treatment even if donor gametes/embryos or surrogacy are used, and regardless of whether treatment is likely to be unsuccessful or using previously retrieved gametes/embryos.
5) Specific coverage components included
- At least four complete oocyte retrievals with unlimited embryo transfers from those retrievals.
- Medical costs related to embryo transfer, including transfers to third parties.
- Coverage includes procedures to screen or diagnose embryos (e.g., preimplantation genetic testing).
6) Annual/lifetime caps
- Insurers may cap coverage for infertility at a lifetime limit of $100,000.
7) Applicability and coordination
- Applicable to multiple types of health coverage formats:
- Commercial health plans (group/blanket policies).
- Nonprofit hospital service corporations.
- Nonprofit medical service corporations.
- Health Maintenance Organizations (HMOs).
- Sections align with both traditional health insurance policies and nonprofit health plan types.
8) Administrative and clinical governance
- Clinical guidelines used to inform coverage must align with current guidelines from established bodies (ASRM, ASCO, etc.).
- The act does not override clinical judgment; guidelines supplement medical decision-making.
Effective date
- Takes effect January 1, 2027.
Who is affected
- Insurance issuers offering health, nonprofit hospital service, nonprofit medical service, and HMO products in Rhode Island.
- Individual insureds (women 25–42) seeking infertility diagnosis, treatment, or fertility preservation, including use of donor gametes/embryos or surrogacy.
Timeline and procedures
- Introduction and referral occurred in February 2026; scheduled for hearing in May 2026.
- If enacted, provisions would apply to policies delivered/renewed after January 1, 2027.
Notes
- The bill emphasizes eliminating coverage barriers and ensuring parity for infertility services with other medical treatments, while maintaining reasonable cost-sharing and medical-necessity requirements.
Compiled from official sources — confirm details with the bill’s official record.
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