SB 5121 — Concerning health plan coverage of fertility-related services.

S-1713.1S-0341.1 SUBSTITUTE SENATE BILL 5121 State of Washington 69th Legislature 2025 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Frame, Cleveland, Bateman, Cortes, Liias, Nobles, Orwall, Pedersen, Riccelli, Saldaña, Valdez, Wellman, and C.

Wilson)Wilson READPrefiled FIRST12/30/24. TIME 02/21/25.

Read first time 01/13/25.

Referred to Committee on Health & Long-Term Care.

1 SSBSB 5121 (2) The legislature, therefore, intends to provide coverage for the diagnosis of and treatment for infertility, as well as for standard fertility preservation services.

(1) Group health plans other than small group health plans issued or renewed on or after January 1, 2026, must include coverage for standard fertility preservation services.

(2) Group health plans other than small group health plans issued or renewed on or after January 1, 2027, must include coverage for the diagnosis of and treatment for infertility.

(4) Group health plans other than small group health plans may not include:

(a) "Diagnosis of and treatment for infertility" means the recommended procedures and medications from the direction of a licensed physician, osteopathic physician, physician assistant, or advancedosteopathic registeredphysician nurse practitioner that are consistent with established, published, or approved medical practices or professional p.guidelines from the American college of obstetricians and gynecologists or the American society for reproductive medicine.

2p. SSB 5121 guidelines from the American college of obstetricians and gynecologists or the American society for reproductive medicine.

2 SB 5121 (b) "Infertility" means a disease, condition, or status characterized by:

(iii) A licensed physician's,physician's osteopathic physician's, physician assistant's, or advancedosteopathic registeredphysician's nurse practitioner's findings based on a patient's medical, sexual, and reproductive history, age, physical findings, or diagnostic testing;

Coverage must provide for two completed oocyte retrievals with unlimited embryo transfers in accordance with the p.guidelines of the American society for reproductive medicine, using single embryo transfer when recommended and medically appropriate.

3p. SSB 5121 guidelines of the American society for reproductive medicine, using single embryo transfer when recommended and medically appropriate.

3 SB 5121 (3) The benefits must be provided to enrollees, including covered spouses and covered nonspouse dependents, to the same extent as other pregnancy-related benefits.

(a) "Diagnosis of and treatment for infertility" means the recommended procedures and medications from the direction of a licensed physician, osteopathic physician, physician assistant, or advancedosteopathic registeredphysician nurse practitioner that are consistent with established, published, or approved medical practices or professional guidelines from the American college of obstetricians and gynecologists or the American society for reproductive medicine.

(iii) A licensed physician's,physician's osteopathic physician's, physician assistant's, or advancedosteopathic registeredphysician's nurse practitioner's findings based on a patient's medical, sexual, and reproductive history, age, physical findings, or diagnostic testing;

p.(c) "Regular, unprotected sexual intercourse" means no more than 12 months of unprotected sexual intercourse for a woman under the age of 35 or no more than six months of unprotected sexual intercourse for a woman 35 years of age or older.

4Pregnancy SSBresulting 5121in (c)p. "Regular, unprotected sexual intercourse" means no more than 12 months of unprotected sexual intercourse for a woman under the age of 35 or no more than six months of unprotected sexual intercourse for a woman 35 years of age or older.

Pregnancy4 resultingSB in5121 miscarriage does not restart the 12-month or six-month time period to qualify as having infertility.

p.NEW SECTION.

5 SSB 5121 NEW SECTION.

65 SSBSB 5121