Mass. bill would expand required insurance coverage for infertility diagnosis and treatment

A bill filed in the Massachusetts House would require private health carriers to cover a broad range of infertility diagnosis and treatment services and to bar insurers from applying coverage rules that single out fertility care.

House Bill 4551, filed Sept. 19, 2025 and reported by the House Committee on Financial Services on Sept. 29, 2025, defines “infertility” to include: a licensed physician’s findings based on medical and reproductive history and testing; the need for medical intervention including donor gametes or gestational carrier; failure to achieve a live birth after a specified period of unprotected intercourse (12 months for people under 35, 6 months for people 35 and older); and impairments due to medical, genetic, or iatrogenic causes. The committee reported the accompanying bill “ought to pass.”

The bill would require coverage for medically necessary expenses of diagnosis and treatment of infertility and lists covered services explicitly. Required benefits include a minimum of six oocyte retrievals and unlimited fresh and frozen embryo transfers, embryo transfer procedures, artificial insemination, surgical sperm extraction, third‑party reproduction such as IVF using donor egg, sperm, or embryo or a gestational carrier, and procedures to screen or diagnose an embryo before transfer, including preimplantation genetic testing for aneuploidy, structural rearrangements, and monogenic disorders.

The measure prohibits carriers and participating providers, as those terms are defined in chapter 176O, from imposing eligibility conditions beyond what the law provides; treating fertility medications differently from other prescription drugs; denying coverage based on a patient’s participation in services provided by or to a third party (which the bill defines to include any fresh or cryopreserved gamete or embryo and gestational carriers); excluding services because of the quantity of cryopreserved material; or applying deductibles, copayments, coinsurance, benefit maxima, waiting periods, or other limitations that differ from those applied to non‑infertility benefits. The bill also bars limits based solely on non‑medical factors such as the number of attempts, dollar amounts, or age, and forbids different benefits or requirements for different diagnostic groups.

Coverage limitations must be based on written clinical guidelines and a patient’s medical history. The bill names standards developed by the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, and the Society for Assisted Reproductive Technology as possible bases for such guidelines. It further provides that issuing clinical guidelines that are not reasonably current or that lack specific citations would constitute an unfair and deceptive act under section 2 of chapter 93A.

Consistent with Massachusetts anti‑discrimination law, the bill directs that coverage be provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. The text also states that the section should not be construed to deny existing rights or benefits under other laws, plans, or policies, and that it should not interfere with a medical provider’s clinical judgment.

Sections 2 and 3 of the bill make parallel amendments to section 8K of chapter 176A and section 4J of chapter 176B to ensure the same definitions, coverage requirements, prohibitions, and guideline rules apply across those insurance statutes. The document included with the committee report contains no fiscal note or recorded floor vote.

The committee report was signed for the committee by James M. Murphy. The bill was filed in the 194th General Court as House No. 4551 on Sept. 19, 2025 and reported by the committee on Sept. 29, 2025. Effective dates and any implementing regulations or fiscal impacts are not specified in the text provided.