LD 213
pg. 3
Page 2 of 5 An Act To Assist Maine's Infertile Citizens Page 4 of 5
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LR 751
Item 1

 
§4252.__Infertility coverage

 
1.__Definition.__For the purposes of this section,
"infertility" means the disease or condition that results in
the abnormal function of the reproductive system such that a
male is not able to impregnate a female or a female is not
able to become pregnant and maintain a pregnancy to full term
after one year of attempting pregnancy.

 
2.__Coverage.__All group health maintenance organization
contracts that provide for coverage for pregnancy-related
benefits must provide coverage for the diagnosis and treatment
of infertility, including, but not limited to, in vitro
fertilization, embryo transfer, artificial insemination,
gamete intrafallopian tube transfer, zygote intrafallopian
tube transfer and low tubal ovum transfer.

 
3.__Limits.__The coverage required by this section is
subject to the following conditions:

 
A.__The female partner must be 21 years of age or older
and under 45 years of age;

 
B.__For a policy that provides prescription drug coverage,
the policy may not impose special restrictions on
prescription medications or a restriction or limitation on
the number of procedures used for infertility diagnosis or
treatment, except as provided in this subsection;

 
C.__Coverage for procedures for intrauterine insemination
with ovarian stimulation and procedures requiring oocyte
retrieval may be limited in accordance with the following.

 
(1)__The policy may require that the covered
individual has been unable to attain or sustain a
pregnancy through reasonable, less costly medically
appropriate infertility treatments for which coverage
is available under the policy or contract.

 
(2)__The policy may limit the covered individual to a
maximum of 6 completed intrauterine inseminations
with ovarian stimulation, except that if the
individual has a living child, then the policy may
limit coverage to 3 completed intrauterine
inseminations with ovarian stimulation.

 
(3) The policy may limit the covered individual to a
maximum of 4 completed oocyte retrievals, except that
if the individual has a living child, then the policy
may limit coverage to 2 completed oocyte retrievals.


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