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Bill Summary · HB 888

Overview

HB 888 (136th General Assembly, Ohio) introduces requirements and expansions related to insurance coverage and Medicaid coverage for infertility services. The bill amends the health care coverage framework by modifying what constitutes basic health care services and mandating coverage for infertility-related treatments, including assisted reproductive technology (ART) and treatments affecting fertility. It also clarifies Medicaid coverage to align with these changes.

Main purpose and intent

  • To ensure insurance plans that cover basic health care services provide expanded infertility coverage.
  • To require health benefit plans that cover basic services to also cover ART and treatments that impact fertility, with parity in cost-sharing.
  • To mandate Medicaid to cover ART and fertility-related treatments to the same extent as other comparable medical procedures.

Key provisions and changes

  1. I. Basic health care services (Section 1751.01, amended)
  2. Defines basic health care services (A)(1) including preventive services, infertility services, diagnostic/treatment services, emergency/urgent care, etc., and excludes experimental procedures.
  3. Sets a baseline rule: a health insuring corporation (HIC) offering basic health care services must cover all listed basic services unless exceptions apply (A)(1).

  4. Exceptions and alternatives:

    • (A)(2): An HIC may offer coverage for diagnostic and treatment services for biologically based mental illnesses (BBMI) without requiring all other basic services. It may offer BBMIs alone or with supplemental services. If any other basic service is offered, BBMI must be included with all other basic services.
    • (A)(3): An HIC offering basic services may skip BBMI coverage if cost-driven justifications are met. This includes actuarial documentation showing >1% per-year cost increase for BBMI claims over six months, an independent actuary’s opinion that such costs justify premium increases, and a determination by the Superintendent of Insurance, subject to Chapter 119.
    • (A)(4): If permitted by federal law, basic-service coverage shall include infertility diagnostics and exploratory procedures and surgical treatments for certain reproductive conditions (e.g., endometriosis, blocked fallopian tubes, testicular failure).

  5. II. Supplemental health care services (Section 1751.01, as defined)

  6. Lists services that may be offered in addition to basic services (e.g., intermediate/long-term care, dental, vision, mental health, prescription drugs, nursing, physical therapy, etc.).

  7. Includes requirements for prescription drug coverage for BBMI if such services are offered.

  8. III. Specialty health care services

  9. Defines as one subset of supplemental services provided on an outpatient basis.

  10. IV. Definitions

  11. Provides numerous definitions for terms used in the bill (e.g., biologically based mental illnesses, emergency health services, panel plans, open/closed panels, provider, intermediary organization, and more).

  12. Section 3902.65 (New; Assisted Reproductive Technology and Fertility Treatments)

  13. Defines:

    • Assisted reproductive technology (ART): IVF, GIFT, ZIFT, etc. excludes treatments handling only sperm or non-retrieval stimulation-only procedures.
    • Treatment for conditions that impact fertility: includes ovulation stimulation, intrauterine insemination, laparoscopic surgery, endometriosis, PCOS, fibroids, male/female fertility conditions, etc.

  14. Mandate: On and after the effective date, a health benefit plan that covers basic health care services must cover ART and fertility-treatment procedures to the same extent as other female/male fertility-related care, with cost-sharing not exceeding that for other medical procedures.

  15. Section 5164.11 (New; Medicaid coverage)

  16. Mirrors 3902.65 definitions.

  17. Requires Medicaid to cover ART and fertility treatments to the same extent as other procedures for female reproductive care or male infertility treatments.

  18. Section 2 and repeal

  19. Repeals existing section 1751.01 and replaces it with the amended version described above.

Who is affected

  • Health insuring corporations (HICs) that offer basic health care services.
  • Enrollees in plans that cover basic health care services, as well as those seeking infertility or fertility-related care.
  • Medicaid beneficiaries, who would gain coverage for ART and fertility treatments under the bill’s framework.
  • Providers delivering infertility services, ART, and related treatments, including reproductive endocrinologists, obstetricians/gynecologists, and fertility clinics.
  • Actuaries and insurance regulators (Superintendent of Insurance) due to the actuarial certification requirements in the BBMI exception.

Procedural and timeline aspects

  • Effective date: The bill states “on and after the effective date of this section” ART and fertility treatments must be covered; the exact date would be set upon enactment and publication.
  • Regulatory oversight: Superintendent of Insurance determines BBMI-related premium impact approvals under the conditional exemption (A)(3) and requires independent actuary opinions.
  • Federal law considerations: The provision allowing BBMI-related exemptions references compliance “to the extent permitted under federal law.”

Potential impact

  • Increased coverage for infertility services and ART within private insurance plans that cover basic health care services.
  • Standardized parity in cost-sharing for ART and fertility treatments relative to other medical procedures.
  • Expanded Medicaid coverage for infertility-related services, potentially increasing access for low-income individuals and families.
  • Possible premium impacts for some plans due to mandated coverage of higher-cost fertility treatments; offset provisions exist via actuarial demonstrations in BBMI scenarios.

If you’d like, I can tailor this to a specific audience (e.g., policymakers, insurers, or patient advocates) or provide a side-by-side comparison with current Ohio law.

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

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