AN ACT TO increase access to fertility medication under cERTAIN health benefit plans that offer FERTILITY treatment COVERAGE and under the state health plan for teachers and state employees.

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑241.  Fertility treatment coverage.

(a)        The following definitions apply in this section:

(1)        Experimental fertility procedure. – A procedure for which the published medical evidence is not sufficient for the American Society of Reproductive Medicine, its successor organization, or a comparable organization to regard the procedure as an established medical practice.

(2)        Fertility treatment. – A procedure, healthcare product, medication, or healthcare service intended to achieve pregnancy consistent with the established medical practice and professional guidelines published by the American Society of Reproductive Medicine, its successor organization, or a comparable organization.

(3)        Insurer. – As defined in G.S. 58‑3‑167.

(b)        If a health benefit plan offered by an insurer provides coverage for any fertility treatment, then all of the following shall apply:

(1)        Any limitation on coverage for ovulation medication shall not be different than the limitations imposed on other prescription medications.

(2)        No annual or lifetime limitations shall apply to the coverage for ovulation medication and ovulation induction cycles for services provided by healthcare providers that participate in the health benefit plan's provider network.

(c)        Nothing in this section shall be construed to require coverage for fertility treatment or experimental fertility procedures under a health benefit plan.

SECTION 1.(b)  This section is effective October 1, 2024, and applies to insurance contracts issued, renewed, or amended on or after that date.

SECTION 2.  Effective with the January 1, 2025, plan coverage year, the Board of Trustees for the State Health Plan for Teachers and State Employees (State Health Plan) shall remove any annual or lifetime limitations on the coverage for ovulation medication and ovulation induction cycles for services offered in‑network under the State Health Plan. Any limitation on coverage for ovulation medication shall not be different than the limitations imposed on other prescription medications.

SECTION 3.  Effective July 1, 2024, there is appropriated from the General Fund to the Department of Insurance the sum of two million five hundred thousand dollars ($2,500,000) in nonrecurring funds for the purposes of implementing Section 1 of this act, including any associated education campaigns directed toward consumers or insurers about the coverage changes or review of health benefit insurance contracts and policies offered in this State for compliance with that section.

SECTION 4.  Except as otherwise provided, this act is effective when it becomes law.