Bill
S 1413
Requires group health plans to cover infertility diagnosis/treatment and IVF with preimplantation genetic testing in certain cases to prevent serious genetic conditions.
Note on scope and sources
The materials provided for “S.1413” appear to combine text from multiple jurisdictions and unrelated measures (including a New Jersey health-insurance bill on preimplantation genetic testing/IVF, a Massachusetts “victim service funding” amendment, and federal appropriation changes). The clearest and most detailed statutory text and fiscal analysis relate to a New Jersey bill that would require certain health-insurance coverage of preimplantation genetic testing (PGT) and in vitro fertilization (IVF). This summary focuses on that primary substantive text and its estimated fiscal impact; verify the bill’s jurisdiction and current official status on the relevant legislative website.
Purpose and intent
- Require group health coverage (for large-group contracts and specified public benefit programs) of medically necessary infertility diagnosis/treatment and of preimplantation genetic testing performed with IVF in specified circumstances intended to prevent transmission of serious genetic conditions to offspring.
Key provisions
- Coverage requirement: Hospital and medical service corporation contracts (groups >50) that include pregnancy-related benefits must cover:
- Diagnosis and treatment of infertility (including medications, tests, surgery).
- Assisted-reproductive procedures: IVF, embryo transfer, artificial insemination, GIFT, ZIFT, ICSI.
- Preimplantation genetic testing (PGT) performed in conjunction with IVF where the covered persons are not infertile, when used to prevent certain serious genetic conditions.
- Limits and conditions:
- Up to four completed egg retrievals per covered person per lifetime.
- IVF coverage may be limited to persons who have tried reasonable, less-expensive medically appropriate treatments and remain unable to conceive, have not reached the four-retrieval limit, and are 45 years of age or younger.
- Coverage for PGT may be limited to cases where one or both partners meet carrier conditions, including:
1. Both partners known carriers of an autosomal recessive disorder;
2. One partner is a carrier of a single-gene autosomal recessive disorder and they already have an affected offspring;
3. One partner is a known carrier of a single-gene autosomal disorder;
4. One partner is a known carrier of a single X-linked disorder;
5. The condition would cause significant health problems or severe disability if transmitted.
- Definitions and standards:
- “Infertility” defined through clinical criteria aligned with professional practice guidelines.
- “Preimplantation genetic testing” defined as testing embryos created via IVF prior to pregnancy.
- Services must be delivered at facilities meeting American Society for Reproductive Medicine or ACOG standards.
- Cost-sharing (copays/deductibles) and benefit limits apply as for other medical/surgical benefits.
- Exemptions and applicability:
- Religious-employer exception: employers qualifying under federal tax rules may obtain an exclusion for IVF-related coverages, with notice requirements.
- Does not apply to contracts providing benefits to Medicaid/NJ FamilyCare or similar programs administered by the Division of Medical Assistance and Health Services.
- Requirement extends to medical/hospital service corporations, health service corporations, group health insurance policies, and HMO contracts.
Estimated fiscal impact (Office of Legislative Services, New Jersey)
- Total estimated annual State and local government expenditure increase: $210,600 to $1.1 million.
- State Health Benefits Program (SHBP): $93,600 – $500,000 annually.
- Local (SEHBP/SHBP local share): $117,000 – $623,800 annually.
- Cost drivers:
- Estimated average PGT costs per IVF cycle: PGT‑M (single-gene) $7,000–$12,000; PGT‑A $2,250–$4,000; PGT‑SR $5,000–$7,000.
- OLS estimates ~94 births annually in NJ would require PGT under the bill’s scenarios, with program-specific shares noted above.
- Final cost depends on whether plans cover multiple tests per cycle and other coverage design choices.
Who would be affected
- Covered persons (employees and dependents under affected group plans), particularly couples at heightened genetic risk.
- State and local government budgets (SHBP and School Employees’ Health Benefits Program).
- Group insurers, medical service corporations, HMOs, and health-care providers/fertility centers.
- Employers (religious employer exemption available).
Procedural/status (notes)
- The documents show multiple and conflicting entries (introduced dates, committee referrals, and hearings). One listed action: introduced April 10, 2025 and referred to committee (“REFERRED TO CODES” among other committees). A hearing was scheduled for 10/21/2025 in one record. Because the record mixes materials from different jurisdictions and related bills, confirm current status and exact text on the official legislative docket for the relevant state (or federal) body.
Compiled from official sources — confirm details with the bill’s official record.
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