Summary of Bill SB 910 (Session 2025, North Carolina) – Expanding Insurance Coverage/Fertility Care
Purpose
- Expand access to fertility care and related services in North Carolina.
- Recognize infertility as a medical condition and require insurance coverage for fertility care, including diagnostics, treatments, and fertility preservation.
- Include Medicaid coverage and related health workforce education initiatives to improve access and reduce disparities.
Key Provisions
1) Health Insurance Coverage for Fertility Care (Part I)
- Enacts new Section 58-3-241: Fertility and infertility coverage.
- Definitions:
- Fertility diagnostic care: tests, counseling (including genetic counseling), imaging, labs, and related services to assess fertility.
- Fertility treatment: IVF, assisted reproduction, cryopreservation/storage of gametes/embryos, preconception care.
- Infertility: broad definition including medical, genetic, or disability-related factors; includes inability to conceive after specified timeframes, donor gametes/embryos, or certain genetic risks.
- Standard fertility preservation services: counseling, procedures, medications, and storage when medical conditions or treatments threaten fertility, with minimum storage/coverage duration (until age 35 or at least five years, whichever later).
- Coverage requirements:
- Health plans that cover pregnancy-related benefits must also cover infertility: fertility diagnostic care and treatment by licensed providers.
- Minimum coverage inclusions: at least four completed oocyte retrievals; unlimited embryo transfers from any retrieval; unlimited intrauterine insemination (IUI) cycles; unlimited intracervical insemination.
- Coverage for standard fertility preservation services (cryo/storage) for patients with medical conditions likely to impair fertility, with specified minimum storage period (until age 35 or at least five years).
- Prohibitions/limits:
- No discrimination in coverage for fertility medications beyond other prescriptions.
- No denial or exclusion of coverage due to third-party involvement (surrogacy, gestational carriers, or donor gametes).
- No deductibles, copays, or out-of-pocket limits greater than those for other medical conditions.
- No waiting periods, no use of prior diagnoses or disability status to restrict coverage.
- Effective date: October 1, 2027 (applies to plans issued, renewed, or amended on/after that date).
2) Medicaid Coverage for Fertility Care (Part II)
- Requires DHHS to seek CMS approval to implement Medicaid coverage for fertility care, including:
- Fertility diagnostic care, medically necessary ovulation-enhancing drugs, and intrauterine insemination (IUI) aimed at achieving a live birth.
- Minimum lifetime coverage: at least three cycles of ovulation-enhancing medication treatment.
- Funding: Appropriation of $45 million (recurring) from the General Fund for 2026-2027 onward to implement the coverage.
- Effective date: July 1, 2026.
3) Education and Training for Licensing Boards (Part III)
- Adds a new continuing education module (G.S. 90-5.5) emphasizing:
- Non-discrimination based on sexual orientation/identity in medical settings.
- Improving access to services for LGBTQ+ individuals.
- Family-building options for LGBTQ+ individuals.
- Applies to physicians, nurses, midwives, and related licensing boards; boards must adopt rules to implement by Oct. 1, 2026.
4) Fertility Care Resource Hub (Part IV)
- Creates a statewide Fertility Care Resource Hub funded with $1 million annually (starting 2026-2027).
- Hub to provide:
- Evidence-based information on fertility care options.
- Referrals to eligible fertility clinics and providers.
- Guidance on navigating insurance coverage.
- Information on financial assistance options.
- Effective July 1, 2026.
5) Study on Disparities and Access (Part IV)
- Appropriations of $70,000 (nonrecurring) for 2026-2027 to study affordability, accessibility, and practicality of fertility resources for underrepresented groups.
- Tasks include assessing rural/provider availability, potential program adjustments, training for culturally competent care, and recommendations to reduce disparities.
- Final findings due by April 1, 2028.
6) Right to Access Assisted Reproductive Technology and Contraceptives (Part V)
- Establishes a new Article 1Q affirming the right to engage in assisted reproductive technology and contraception.
- Defines terms (assisted reproductive technology, contraception, health care provider, etc.).
- States that NC law does not prohibit activities related to ART or contraception, and clarifies construction relative to health and safety laws.
Effective Dates (Summary)
- Part I: October 1, 2027 (most provisions for private health plans).
- Part II: July 1, 2026 (Medicaid-related provisions).
- Part III: October 1, 2026 (education/training modules).
- Part IV: July 1, 2026 (Fertility Care Resource Hub; study begins 2026-2027).
- Part VI: General effective date as specified.
Impact Considerations
- Expands coverage for fertility diagnostics, treatments (including IVF), and preservation.
- Could reduce out-of-pocket costs and financial hardship for individuals/couples seeking fertility care.
- Aims to improve equity by addressing disparities in access, particularly for LGBTQ+ individuals and those in underrepresented groups.
- Requires regulatory action by multiple boards and state agencies, with funding to implement Medicaid expansion and public information resources.
