Mass. bill would require insurers and state plans to cover fertility diagnostics, treatments and storage

A bill reported favorably by the House Committee on Financial Services on Sept. 29 would require Massachusetts state health plans, MassHealth and private insurers that provide pregnancy-related benefits to cover fertility diagnostic care and fertility treatments and to extend certain cryopreservation storage coverage.

The legislation, House No. 4550, "An Act relative to modern family building," defines "fertility diagnostic care" and "fertility treatment" and sets minimum coverage standards. It directs the Group Insurance Commission to provide coverage to active and retired commonwealth employees insured by the commission; it requires MassHealth to cover specified diagnostic services, ovulation-enhancing drugs and intrauterine insemination (IUI); and it amends multiple insurance statutes to align private plans with those requirements.

Under the bill's terms, "fertility diagnostic care" includes procedures, products, genetic testing, medications and services intended to provide information and counseling about an individual's fertility, including laboratory assessments and imaging studies. "Infertility" is defined broadly, including physician findings, the need for medical intervention such as donor gametes, inability to achieve pregnancy after set time periods described in the text, and an increased risk of transmitting a serious inheritable genetic or chromosomal abnormality.

Minimum benefits spelled out in the bill include no fewer than four completed oocyte retrievals; unlimited embryo transfers from covered retrievals or other completed retrievals; unlimited cycles of intrauterine insemination; and unlimited 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 bill bars insurers from applying exclusions, limitations or restrictions to fertility medications that differ from those applied to other prescription medications. It also forbids denial of coverage for fertility treatment based on participation in services provided by a third party, including gestational carriers and surrogates, or because of the donation or use of a third party's genetic material. The bill says no conditions — including prior treatment, age, sexual orientation, gender identity or familial status — may be imposed to receive benefits under its Group Insurance Commission provision.

For MassHealth recipients, the bill requires coverage for fertility diagnostic care, medically necessary ovulation-enhancing drugs and monitoring, and IUI intended to treat infertility, and specifies at least three cycles of ovulation-enhancing medication treatment over a recipient's lifetime.

Separately, the bill directs the bureau of health professions licensure, in coordination with reproductive medicine organizations, to develop a professional development training module on resources and services for LGBTQ individuals and couples seeking to expand their families. The training is to be accepted for up to 2 continuing professional development credits by the boards of registration in medicine, midwifery and nursing.

The Office of Health Equity is charged with conducting a study on the affordability, accessibility and practicality of resources and services available to LGBTQ individuals and couples seeking to expand their families. The office's scope includes examining availability of assisted reproduction providers in rural areas, funding needs, provider training curricula, out-of-pocket cost disparities, cryobank practices and recommendations to reduce disparities. The bill requires the office to submit findings to relevant legislative committees and clerks by Dec. 31, 2026.

Several sections of the bill add parallel language across chapters of the General Laws (including chapters 32A, 112, 118E, 175, 176A, 176B and 176G) to ensure consistent application of definitions and minimums across state plans, MassHealth and private insurers. The text also inserts uniform language extending coverage for storage of reproductive tissue until the individual reaches age 35 or for five years, whichever is later, in multiple statutory provisions.

The bill's cover page notes it was filed on Sept. 19, 2025, and that the committee on Financial Services "reports recommending that the accompanying bill (House, No. 4550) ought to pass." The committee signatory on the report is James M. Murphy; the filing petition referenced Representative Natalie M. Higgins and others as petitioners.

The legislation sets staggered effective dates: several coverage sections take effect one year after enactment; the required training curriculum is to be completed within nine months of enactment; and the Office of Health Equity's study is due to the legislature by Dec. 31, 2026.

Details not specified in the bill text include prospective cost estimates to insurers or the state, the number of affected enrollees, and any implementing regulations or administrative processes insurers will use to comply.