HB 4155 — Relating to infertility.

(b) Procedures recommended by a licensed treating practitioner, including but not limited to the storage of reproductive specimens for the period of time deemed medically necessary by the practitioner, that are:

(A) Based on the practitioner’s physical findings and diagnostic testing and an individual’s medical history, sexual history, reproductive history and age;

and (B) Consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology, or a successor organization, for an individual who is at risk of infertility due to:

(i) A medical condition;

or (ii) An expected medication therapy, surgery, radiation, chemotherapy or other medical treatment that is recognized by medical professionals to cause a risk of infertility.

(3) The coverage required by subsection (2) of this section:

(a) Includes, but is not limited to:

(A) A minimum of three completed oocyte retrievals with unlimited embryo transfers in accordance with guidelines of the American Society for Reproductive Medicine, or a succes- sor organization, using single embryo transfer if recommended by a licensed treating prac- titioner and medically effective.

(B) Six completed egg retrievals per lifetime, with unlimited embryo transfers in ac- cordance with the guidelines of the American Society for Reproductive Medicine, using single embryo transfer when recommended and medically appropriate.

(C) Assisted hatching.

(D) Cryopreservation and thawing of embryos.

(E) Embryo biopsy.

(F) Fresh and frozen embryo transfers.

(G) Storage of embryos.

(H) In vitro fertilization, including in vitro fertilization using donor eggs, sperm or embryos, and in vitro fertilization in which the embryo is transferred to a gestational carrier or surrogate.

(I) Intracytoplasmic sperm injection.

(J) Storage of oocytes, sperm and tissue.

(K) Intrauterine insemination.

(L) Cryopreservation of ovarian tissue.

(M) Cryopreservation of testicular tissue.

(N) Cryopreservation and thawing of eggs and sperm.

(O) Consultation and diagnostic testing.

(P) Medications.

(Q) Ovulation induction.

(R) Surgery, including microsurgical sperm aspiration.

(S) Medical and laboratory services that reduce excess embryo creation through egg cryopreservation and thawing.

(b) Must be provided to all beneficiaries under the health benefit plan policy or certif- icate, including a covered spouse and covered dependents other than spouses, to the same extent as other pregnancy-related benefits under the plan.

(4) The health benefit plan may not impose exclusions, limitations or other restrictions [2] A-Eng.

HB 4155 on coverage of:

(a) Medications for the treatment of infertility described in subsection (2) of this section that are not imposed on other prescription benefits under the plan.

(b) Procedures described in subsections (2) and (3) of this section:

(A) Based on an enrollee’s participation in fertility services provided by or to a third party.

(B) That do not apply to other covered procedures under the plan.

(5) Subsection (4) of this section does not permit a health benefit plan to require step therapy for services described in subsections (2) and (3) of this section that are determined by a treating practitioner to be medically necessary.

(6) This section does not require a health benefit plan offered by an insurer described in ORS 743A.067 (7)(e) to reimburse the cost of:

(a) Embryo transfer procedures as part of the coverages described in subsection (3)(a)(A) and (B) of this section;

and (b) Procedures described in subsection (3)(a)(C) to (I) of this section.

(7) The coverage requirements described in this section do not apply to health benefit plans offered by the Oregon Educators Benefit Board and Public Employees’ Benefit Board, unless the Oregon Educators Benefit Board or Public Employees’ Benefit Board elect to provide the coverage.

(8) This section is exempt from ORS 743A.001.

SECTION 3.

ORS 743B.005 is amended to read:

743B.005.

For purposes of ORS 743.004, 743.007, 743.022, 743.416, 743.417, 743.535, 743A.101, 743B.003 to 743B.127, 743B.109, 743B.128, 743B.250 and 743B.323 and section 2 of this 2026 Act:

(1) “Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the Director of the Department of Consumer and Business Services that a carrier is in compliance with the provisions of ORS 743B.012 based upon the person’s examination, including a review of the appropriate records and of the actuarial as- sumptions and methods used by the carrier in establishing premium rates for small employer health benefit plans.

(2) “Affiliate” of, or person “affiliated” with, a specified person means any carrier who, directly or indirectly through one or more intermediaries, controls or is controlled by or is under common control with a specified person.

For purposes of this definition, “control” has the meaning given that term in ORS 732.548.

(3) “Affiliation period” means, under the terms of a group health benefit plan issued by a health care service contractor, a period:

(a) That is applied uniformly and without regard to any health status related factors to an enrollee or late enrollee;

(b) That must expire before any coverage becomes effective under the plan for the enrollee or late enrollee;

(c) During which no premium shall be charged to the enrollee or late enrollee;

and (d) That begins on the enrollee’s or late enrollee’s first date of eligibility for coverage and runs concurrently with any eligibility waiting period under the plan.

(4) “Bona fide association” means an association that:

(a) Has been in active existence for at least five years;

(b) Has been formed and maintained in good faith for purposes other than obtaining insurance;

[3] A-Eng.

HB 4155 (c) Does not condition membership in the association on any factor relating to the health status of an individual or the individual’s dependent or employee;

(d) Makes health insurance coverage that is offered through the association available to all members of the association regardless of the health status of the member or individuals who are eligible for coverage through the member;

(e) Does not make health insurance coverage that is offered through the association available other than in connection with a member of the association;

(f) Has a constitution and bylaws;

and (g) Is not owned or controlled by a carrier, producer or affiliate of a carrier or producer.

(5) “Carrier” means any person who provides health benefit plans in this state, including:

(a) A licensed insurance company;

(b) A health care service contractor;

(c) A health maintenance organization;

(d) An association or group of employers that provides benefits by means of a multiple employer welfare arrangement and that:

(A) Is subject to ORS 750.301 to 750.341;

or (B) Is fully insured and otherwise exempt under ORS 750.303 (4) but elects to be governed by ORS 743B.010 to 743B.013;

or (e) Any other person or corporation responsible for the payment of benefits or provision of ser- vices.

(6) “Dependent” means the spouse or child of an eligible employee, subject to applicable terms of the health benefit plan covering the employee.

(7) “Eligible employee” means an employee who is eligible for coverage under a group health benefit plan.

(8) “Employee” means any individual employed by an employer.

(9) “Enrollee” means an employee, dependent of the employee or an individual otherwise eligible for a group or individual health benefit plan who has enrolled for coverage under the terms of the plan.

(10) “Exchange” means the health insurance exchange as defined in ORS 741.300.

(11) “Exclusion period” means a period during which specified treatments or services are ex- cluded from coverage.

(12) “Financial impairment” means that a carrier is not insolvent and is:

(a) Considered by the director to be potentially unable to fulfill its contractual obligations;

or (b) Placed under an order of rehabilitation or conservation by a court of competent jurisdiction.

(13)(a) “Geographic average rate” means the arithmetical average of the lowest premium and the corresponding highest premium to be charged by a carrier in a geographic area established by the director for the carrier’s:

(A) Group health benefit plans offered to small employers;

or (B) Individual health benefit plans.

(b) “Geographic average rate” does not include premium differences that are due to differences in benefit design, age, tobacco use or family composition.

(14) “Grandfathered health plan” has the meaning prescribed by rule by the United States Sec- retaries of Labor, Health and Human Services and the Treasury pursuant to 42 U.S.C.

18011(e) that is in effect on January 1, 2017.

(15) “Group eligibility waiting period” means, with respect to a group health benefit plan, the [4] A-Eng.

HB 4155 period of employment or membership with the group that a prospective enrollee must complete be- fore plan coverage begins.

(16)(a) “Health benefit plan” means any:

(A) Hospital expense, medical expense or hospital or medical expense policy or certificate;

(B) Subscriber contract of a health care service contractor as defined in ORS 750.005;

or (C) Plan provided by a multiple employer welfare arrangement or by another benefit arrange- ment defined in the federal Employee Retirement Income Security Act of 1974, as amended, to the extent that the plan is subject to state regulation.

(b) “Health benefit plan” does not include:

(A) Coverage for accident only, specific disease or condition only, credit or disability income;

(B) Coverage of Medicare services pursuant to contracts with the federal government;

(C) Medicare supplement insurance policies;

(D) Coverage of TRICARE services pursuant to contracts with the federal government;

(E) Benefits delivered through a flexible spending arrangement established pursuant to section 125 of the Internal Revenue Code of 1986, as amended, when the benefits are provided in addition to a group health benefit plan;

(F) Separately offered long term care insurance, including, but not limited to, coverage of nurs- ing home care, home health care and community-based care;

(G) Independent, noncoordinated, hospital-only indemnity insurance or other fixed indemnity in- surance;

(H) Short term health insurance policies;

(I) Dental only coverage;

(J) Vision only coverage;

(K) Stop-loss coverage that meets the requirements of ORS 742.065;

(L) Coverage issued as a supplement to liability insurance;

(M) Insurance arising out of a workers’ compensation or similar law;

(N) Automobile medical payment insurance or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance;

or (O) Any employee welfare benefit plan that is exempt from state regulation because of the fed- eral Employee Retirement Income Security Act of 1974, as amended.

(17) “Individual health benefit plan” means a health benefit plan:

(a) That is issued to an individual policyholder;

or (b) That provides individual coverage through a trust, association or similar group, regardless of the situs of the policy or contract.

(18) “Initial enrollment period” means a period of at least 30 days following commencement of the first eligibility period for an individual.

(19) “Late enrollee” means an individual who enrolls in a group health benefit plan subsequent to the initial enrollment period during which the individual was eligible for coverage but declined to enroll.

However, an eligible individual shall not be considered a late enrollee if:

(a) The individual qualifies for a special enrollment period in accordance with 42 U.S.C.

300gg or as prescribed by rule by the Department of Consumer and Business Services;

(b) The individual applies for coverage during an open enrollment period;

(c) A court issues an order that coverage be provided for a spouse or minor child under an employee’s employer sponsored health benefit plan and request for enrollment is made within 30 [5] A-Eng.

HB 4155 days after issuance of the court order;

(d) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different health benefit plan during an open enrollment period;

or (e) The individual’s coverage under Medicaid, Medicare, TRICARE, Indian Health Service or a publicly sponsored or subsidized health plan, including, but not limited to, the medical assistance program under ORS chapter 414, has been involuntarily terminated within 63 days after applying for coverage in a group health benefit plan.

(20) “Multiple employer welfare arrangement” means a multiple employer welfare arrangement as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C.

1002, that is subject to ORS 750.301 to 750.341.

(21) “Preexisting condition exclusion” means a limitation or exclusion of benefits or a denial of coverage based on a medical condition being present before the effective date of coverage or before the date coverage is denied, whether or not any medical advice, diagnosis, care or treatment was recommended or received for the condition before the date of coverage or denial of coverage.

(22) “Premium” includes insurance premiums or other fees charged for a health benefit plan, including the costs of benefits paid or reimbursements made to or on behalf of enrollees covered by the plan.

(23) “Rating period” means the 12-month calendar period for which premium rates established by a carrier are in effect, as determined by the carrier.

(24) “Representative” does not include an insurance producer or an employee or authorized representative of an insurance producer or carrier.

(25)(a) “Short term health insurance policy” means a policy of health insurance that is in effect for a period of three months or less, including the term of a renewal of the policy.

(b) As used in this subsection, “term of a renewal” includes the term of a new short term health insurance policy issued by an insurer to a policyholder no later than 60 days after the expiration of a short term health insurance policy issued by the insurer to the policyholder.

(26) “Small employer” means an employer who employed an average of at least one but not more than 50 full-time equivalent employees on business days during the preceding calendar year and who employs at least one full-time equivalent employee on the first day of the plan year, determined in accordance with a methodology prescribed by the Department of Consumer and Business Services by rule.

SECTION 4.

“(2)(2) The department may adopt rules necessary to carry out the provisions of this sec-section. tion.

“SECTIONSECTION 5.

The Family Building Fund is established in the State Treasury, separate and distinct from the General Fund, consisting of moneys collected from the portion of as-assess- sessmentsments imposed under ORS 731.804 (3) for the costs of administering the program de-described scribed in section 4 of this 2026 Act.

Moneys in the Family Building Fund are continuously appropriated to the DepartmentDe- partment of Consumer and Business Services to carry out the provisions of section 4 of this 2026 Act.

“SECTION[6] 6.A-Eng.

HB 4155 SECTION 6.

“731.292.731.292.

“(2)(2) All taxes and penalties paid pursuant to the Insurance Code shall be paid to the director and after deductions of refunds shall be paid by the director to the State Treasurer, at the end of every calendar month or more often in the director’s discretion, for deposit in the General Fund to become available for general governmental expenses.

“(3)(3) All premium taxes received by the director pursuant to ORS 731.820 shall be paid by the director to the State Treasurer for deposit in the State Fire Marshal Fund.

“(4)(4) Assessments received by the department under sections 3 and 5, chapter 538, Oregon Laws 2017, and penalties received by the department under section 6, chapter 538, Oregon Laws 2017, shall be paid into the State Treasury and credited to the Health System Fund established under section 2, chapter 538, Oregon Laws 2017.

“(5)(5) Assessments received by the department under ORS 731.804 (3) shall be paid to the Family Building Fund established under section 5 of this 2026 Act.

HASECTION to HB 4155 Page 2 “SECTION 7.

“731.292.731.292.

(1) Except as provided in subsections [(2) and (3)] (2), (3) and (4) of this section, all fees, charges and other moneys received by the Department of Consumer and Business Services or the Director of the Department of Consumer and Business Services under the Insurance Code shall be deposited in the fund created by ORS 705.145 and are continuously appropriated to the depart-department ment for the payment of the expenses of the department in carrying out the Insurance Code.

“(2)(2) All taxes and penalties paid pursuant to the Insurance Code shall be paid to the director and after deductions of refunds shall be paid by the director to the State Treasurer, at the end of every calendar month or more often in the director’s discretion, for deposit in the General Fund to become available for general governmental expenses.

“(3)(3) All premium taxes received by the director pursuant to ORS 731.820 shall be paid by the director to the State Treasurer for deposit in the State Fire Marshal Fund.

“(4)(4) Assessments received by the department under ORS 731.804 (3) shall be paid to the Family Building Fund established under section 5 of this 2026 Act.

“SECTIONSECTION 8.

“731.804.731.804.

(1) Except as otherwise provided in this section, each authorized insurer doing busi-business ness in this state shall pay assessments that the Director of the Department of Consumer and Business Services determines are necessary to support the legislatively authorized budget of the Department of Consumer and Business Services with respect to functions of the department under the Insurance Code.

The director shall determine the assessments according to one or more per-percentage centage rates establishedes- tablished by the director by rule.

The director shall specify in the rule when as-assessments sessments shall be made and payments shall be due.

In the case of reciprocal insurers, the amount of[7] savingsA-Eng. paid or credited to the accounts of subscribers shall be deducted from the gross amount of premiums.

HB 4155 of savings paid or credited to the accounts of subscribers shall be deducted from the gross amount of premiums.

In establishing the amounts to be col-collected lected under this subsection,sub- section, the director shall take into consideration the expenses of the depart-department ment for administering the Insurance Code and the fees collected under subsection (2) of this section.

“(a)(a) Each rate shall be based on such expenses of the department ascribed by the director to the line of insurance for which the rate is established.

“(b)(b) Each rate shall be applied to the gross amount of premium received by an insurer or its insurancein- surance producers for the applicable line of insurance as provided in this subsection.

“(2)(2) The director may collect fees for specific services provided by the department under the InsuranceIn- surance Code according to a schedule of fees established by the director by rule.

“(3)(a)(3)(a) Notwithstanding the provisions of ORS 743A.067 (7)(e) and 743A.067 (9), for the purpose of mitigating inequity in the health insurance market, the director may assess a fee on any insurer that offers a health benefit plan, as defined in ORS 743B.005, that is exempt from a provision of ORS chapter 743A or other provision of the Insurance Code that requires specified coverage by health HA to HB 4155 Page 3 benefit plans.

“(b)(b) Any fees collected under paragraph (a) of this subsection must be the actuarial equivalent of costs attributed to the provision and administration of the required coverage by an insurer that is not exempt.

“(c)(c) Nothing in this section limits the authority of the director to enforce the provisions of ORS chapter 743A if an insurer unlawfully fails to comply.

“(d)(d) Notwithstanding ORS 646A.628, fees paid in accordance with paragraph (a) of this sub-subsection section shall be deposited in the [General Fund to become available for general governmental expenses] Family Building Fund established under section 5 of this 2026 Act.

“(4)(4) Establishment and amendment of the schedule of fees under subsection (2) of this section are subject to prior approval of the Oregon Department of Administrative Services and shall be within the budget authorized by the Legislative Assembly as that budget may be modified by the Emergency Board.

“(5)(5) The director may not collect an assessment under subsection (1) of this section from any of the following persons:

“(a)(a) A fraternal benefit society complying with ORS chapter 748.

“(b)(b) Any person or class of persons designated by the director by rule.

“(6)(6) The director may not collect an assessment under subsection (1) of this section with respect to premiums received from any of the following policies:

“(a)(a) Workers’ compensation insurance policies.

“(b)(b) Wet marine and transportation insurance policies.

“(c)(c) Any category of policies designated by the director by rule.”.rule.

DeleteSECTION lines9. 42 through 45 and delete page 8.

HASection 2 of this 2026 Act applies to HBpolicies 4155or Pagecertificates 4issued, renewed or extended on or after January 1, 2027.

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