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SB 572

Relating to the Oregon Racial Justice Act.

2025 Regular Session Introduced by Wlnsvey Campos and 6 co-sponsors

Parities require plans that cover fertility treatment to remove annual/lifetime caps on in-network ovulation meds and induction cycles.

In committee upon adjournment.
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Bill Summary · SB 572

SB 572 — Greater Access to Fertility Medication (North Carolina)

Status: Passed 1st Reading (introduced Feb 20 / March 26, 2025)
Primary topic areas: Insurance regulation; prescription drug coverage parity; State Health Plan benefits; appropriations

Purpose / Intent

SB 572 requires parity in how health benefit plans (and the State Health Plan for Teachers and State Employees) treat ovulation medications and ovulation induction cycles when the plan already offers any fertility treatment coverage. The bill is intended to increase access to fertility medications by preventing plans from applying special annual or lifetime limits that do not apply to other prescription drugs.

Key provisions

  • Adds a new statutory section (proposed G.S. 58‑3‑241) with definitions and coverage rules for fertility treatment.
    • Defines “fertility treatment” (procedures, medications, services intended to achieve pregnancy consistent with ASRM or comparable professional guidance).
    • Defines “experimental fertility procedure” (procedures lacking sufficient published evidence to be considered established practice).
  • Parity rules for private health plans:
    • If a health benefit plan covers any fertility treatment, then:
    • Any limitation on coverage for ovulation medication must be the same as limitations applied to other prescription medications.
    • No annual or lifetime limits may be applied to coverage for ovulation medication or to ovulation induction cycles for services provided by in‑network healthcare providers.
    • The section explicitly does not require a plan to cover fertility treatment or experimental fertility procedures; it only governs plans that already provide fertility coverage.
  • State Health Plan (teachers & state employees):
    • Effective for the January 1, 2026 plan year, the State Health Plan Board must remove any annual or lifetime limits on in‑network coverage for ovulation medication and ovulation induction cycles. Any limitation on ovulation medication must match limits on other prescription drugs.
  • Appropriation to offset State Health Plan costs:
    • $300,000 recurring from the General Fund to the Department of State Treasurer for FY 2025–26, and
    • $600,000 recurring for FY 2026–27, for increased State Health Plan costs attributable to implementing the change.
  • Effective dates:
    • Insurance contract changes: apply to contracts issued, renewed, or amended on or after October 1, 2025.
    • State Health Plan changes: apply beginning with the January 1, 2026 plan year.
    • Appropriation effective July 1, 2025.

Who is affected

  • Insurers and group health plans in North Carolina that already provide any fertility treatment coverage — they must apply prescription‑drug parity for ovulation medications and cannot impose annual/lifetime caps on in‑network ovulation medications or ovulation induction cycles.
  • Enrollees (members) of those plans — particularly individuals using ovulation medications or in‑network ovulation induction services.
  • The North Carolina State Health Plan enrollees (state employees, teachers, retirees) — the Plan must amend in‑network benefit limits as noted.
  • State budget — modest recurring appropriations to the State Health Plan to cover projected cost increases.

Practical impact / considerations

  • Access: Removes certain coverage barriers (special annual/lifetime caps) for ovulation medications and in‑network ovulation induction cycles in plans that already cover fertility treatment.
  • Cost: Could increase utilization of medication and induction services; the bill includes a targeted appropriation to help the State Health Plan absorb higher costs in the near term.
  • Scope: The bill does not force plans to add fertility treatment coverage — it only sets rules for plans that already include any fertility benefits. Experimental procedures remain outside the mandate.
  • Implementation: Insurers will need to update plan documents and authorization rules for affected contracts effective Oct 1, 2025; the State Health Plan must enact changes for the 2026 plan year.

Procedural note

  • According to the provided bill information, SB 572 has passed its first reading and contains the statutory, effective‑date, and appropriation language summarized above.

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

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