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Bill

HR 8119

HOPE with Fertility Services Act

119th Congress Introduced by Jack Bergman and 19 co-sponsors

The bill requires group health plans and insurers to cover infertility treatments and preservation, aligning benefits with obstetrical care and prohibiting restrictive practices.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 8119

Purpose and intent

  • HR 8119, the HOPE with Fertility Services Act, aims to guarantee coverage for infertility treatment and related fertility preservation when such services are part of a group health plan or group health insurance offering obstetrical services.
  • The core objective is to ensure that individuals with infertility or iatrogenic infertility have access to comprehensive treatments without being impeded by insurance limitations, aligning coverage with existing obstetrical care where relevant.

Key provisions and changes

  • New section added to ERISA (Section 714A): Establishes standards relating to benefits for treatment of infertility and iatrogenic infertility.
    • Required coverage (general rule):
    • Group health plans and private group health insurance issuers must cover infertility treatments.
    • Coverage extends to infertility treatments that are already covered if the plan covers obstetrical services.
    • Coverage must include standard fertility preservation services when a medically necessary treatment may cause iatrogenic infertility.
    • Definitions (central terms):
    • “Infertility” includes medical conditions or histories meeting criteria such as inability to conceive after 12 months of unprotected intercourse, failure to achieve pregnancy under medical treatment, or conditions affecting ovulation or reproductive hormones.
    • “Infertility or iatrogenic infertility treatment” covers both assisted reproductive technologies (e.g., IVF, egg/embryo cryopreservation, egg/embryo donation, ICSI) and certain non–egg/sperm handling procedures (e.g., ovulation induction, genetic screening, sperm cryopreservation, intrauterine insemination).
    • “Iatrogenic infertility” refers to fertility impairment caused by medical procedures, radiation, chemotherapy, or myeloablative conditioning.
    • Coverage scope (c):
    • Plans must provide comprehensive coverage for infertility or iatrogenic infertility treatments, subject to medical facility standards and participant eligibility.
    • Financial and treatment requirements (d):
    • Coverage may include usual cost-sharing (co-pays, coinsurance, deductibles) and limits, but these must not be more restrictive than those for other medical/surgical benefits.
    • Prohibitions (e):
    • No incentives to deter pursuing infertility treatments.
    • No prohibitions on discussing infertility treatments with patients.
    • No penalties or reduced reimbursement for providers offering covered infertility services.
    • Utilization management (g):
    • For the first five plan years post-enactment, plans that use utilization management tools must analyze and report:
      • Terms and applicability to infertility benefits.
      • The evidentiary standards used.
      • Consistency with clinical guidelines.
      • The specific outcomes of applying these tools to infertility benefits.
    • Annual reporting to the Secretary for the first five years, with a potential extension if violations or complaints arise afterward.
    • If noncompliance is found, plans must outline corrective actions and provide additional analyses within 45 days; failure to comply could trigger notifications to enrollees and a public report.
    • Notice to participants (h):
    • Beginning in the second plan year after enactment, plans must notify participants about the infertility coverage as regulated by Secretary’s rules.
    • Effective date (i):
    • Applies to plan years beginning on or after January 1, 2027.
  • Enforcement and penalties (b):
    • The bill adds an enforcement mechanism under ERISA:
    • Civil penalties up to $100 per day for denying required infertility coverage.
    • Penalties for failing to submit required analysis (up to $100 per day).
  • Conforming amendments (c):
    • Updates cross-references in ERISA to include the new section 714A with existing sections governing health plans and coverage.

Who/what is affected

  • Affected entities:
    • Group health plans (employer-sponsored) and health insurance issuers that offer group health plans.
  • Affected individuals:
    • Participants and beneficiaries with infertility or at risk of iatrogenic infertility who would utilize fertility treatments or preservation services.
  • Facilities and providers:
    • Medical facilities and providers delivering covered infertility or fertility preservation services must meet standards set by federal/state agencies to qualify for coverage.

Procedural and timeline aspects

  • Regulatory framework established in ERISA, with enforcement and reporting provisions.
  • Effective date: plan years beginning on or after January 1, 2027.
  • Utilization management reporting:
    • First five plan years post-enactment require annual analyses submitted to the Secretary.
    • After five years, the Secretary may require reporting in cases of noncompliance or complaints.
  • Transparency and notice:
    • Plans must begin notifying enrollees about the coverage starting in the second plan year post-enactment, following Secretary regulations.

Potential impact and considerations

  • Expands and standardizes infertility coverage for many employer-sponsored plans and group policies.
  • Introduces regulatory oversight of utilization management practices for fertility benefits, with data collection and public reporting to monitor compliance.
  • Creates penalties to deter denial or noncompliance with mandated infertility coverage.
  • Balances patient access with existing medical necessity and cost-sharing norms, ensuring parity with other medical benefits.

If you’d like, I can provide a side-by-side comparison with current ERISA standards or potential fiscal implications based on hypothetical enrollment scenarios.

Compiled from official sources — confirm details with the bill’s official record.

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