Mass. bill would require insurer coverage for fertility care, expand LGBTQ family-building supports

Representative Natalie M. Higgins filed House Bill No. 1190 on Jan. 16, 2025, proposing statewide requirements for insurer coverage of fertility diagnostic care and fertility treatment and additional measures aimed at improving access to family-building services in Massachusetts.

The bill would add new and amended sections across multiple chapters of the General Laws to require the Group Insurance Commission (for commonwealth employees), MassHealth, and private insurers that provide pregnancy-related benefits to cover fertility diagnostic care and fertility treatment "to the same extent that benefits are provided for other pregnancy-related procedures." The filing lists Lindsay N. Sabadosa, James B. Eldridge and Jason M. Lewis among additional petitioners and identifies referral to the Financial Services committee.

Key coverage provisions include definitions that tie clinical standards to guidance from the American Society for Reproductive Medicine and a requirement that covered plans provide at least four completed oocyte retrievals; unlimited embryo transfers from retrievals covered under the law or from other completed retrievals; and unlimited cycles of intrauterine insemination (IUI) and intracervical insemination. The bill states that insurers are not required to cover nonmedical costs related to procurement of gametes, donor embryos or surrogacy services.

The proposal also bars insurers from applying exclusions, limitations or other restrictions to fertility medications that differ from restrictions on other prescription drugs; it prohibits denial of coverage because a covered individual participates in fertility services provided by third parties (including gestational carriers or surrogates); and it forbids imposing different deductibles, copayments, coinsurance, benefit maximums or other limitations on services related to infertility than those that apply to other clinical services.

Amendments in several chapters would require that coverage for storage of cryopreserved reproductive tissue extend "until the individual reaches the age of 35, or for a period of 5 years, whichever is later." That storage-extension language appears in amendments to chapter 175, chapter 176A, chapter 176B and chapter 176G and is added to existing sections addressing storage.

The bill would add a Section 5P to chapter 112 directing the bureau of health professions licensure, in coordination with the American Society for Reproductive Medicine or the Society for Assisted Reproductive Technology, to develop a professional-development training module on resources and services available to LGBTQ couples and individuals seeking to expand their families. The module is to include preventing discrimination in medical settings, improving access, and outlining family-building options; the text says the module shall be accepted by the relevant licensing boards as up to two continuing professional development credits and that the curriculum must be completed within nine months of enactment.

For MassHealth recipients, the bill specifies that the division shall provide coverage for fertility diagnostic care, medically necessary ovulation-enhancing drugs and related monitoring services and intrauterine insemination intended to achieve a live birth; it includes a lifetime minimum of three cycles of ovulation-enhancing medication treatment for a medical assistance recipient.

The bill directs the Office of Health Equity to study affordability, availability and access to assisted reproduction and other family-building services for LGBTQ individuals and couples, including provider availability in rural and geographically isolated areas, out-of-pocket costs, cryobank policies for nontraditional families, and recommendations to reduce disparities. The office is to solicit data via memoranda of understanding with the Center for Health Information and Analysis, the Group Insurance Commission and MassHealth and to submit findings and recommendations to legislative committees by Dec. 31, 2026.

Several sections of the bill specify effective dates: multiple insurance-coverage sections (including the new Section 17U of chapter 32A and several private-insurer provisions) would take effect one year after enactment; the training curriculum has a nine‑month completion deadline; and the Office of Health Equity report has the Dec. 31, 2026 deadline.

The filing itself does not record committee action, legislative debate, an amendment process or a vote; it is an introduced bill. The docket lists filing dates for petitioners and notes the bill number as House No. 1190.