HOPE with Fertility Services Act

Mandated Coverage for Infertility: Group health plans that provide coverage for obstetrical services will be required to provide coverage for infertility treatments. This includes treatments involving the handling of human egg, sperm, and embryo, as well as treatments that do not involve such handling (Section 2(a)(1); Section 2(b)(3)).

Protection Against Iatrogenic Infertility: The bill ensures coverage for fertility preservation when a medically necessary treatment—such as surgery, radiation, or chemotherapy—causes or is expected to cause infertility (Section 2(a)(2); Section 2(b)(1)).

Fair Cost-Sharing and Limits: The Act prevents health plans from imposing cost-sharing requirements or coverage limits that are more restrictive than the predominant limits applied to other medical and surgical benefits in the plan (Section 2(c)).

Protection of Provider-Patient Discussions: Insurance issuers are prohibited from preventing a healthcare provider from discussing infertility treatments or medical options with a patient (Section 2(e)(2)).

Financial Accountability for Non-Compliance: The Secretary has the authority to assess civil penalties against health insurance issuers that fail to provide required coverage or fail to submit required analyses, which may serve as a mechanism for enforcement (Section 2(b)).

Potential for Continued Cost-Sharing: While the bill limits how restrictive costs can be, it explicitly allows for coverage limits (like pre-authorization) and cost-sharing requirements (such as copayments and deductibles) to remain in place (Section 2(c)).

Continued Use of Management Tools: The bill notes that the requirements do not prevent a group health plan or issuer from using utilization management tools (Section 2(f)(2)).