H.R. 8119

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8119 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8119

To ensure coverage for the treatment of infertility for certain 
conditions.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 26, 2026

Mr. Nunn of Iowa (for himself, Ms. Wasserman Schultz, Ms. Malliotakis, 
Ms. Houlahan, Ms. Lee of Florida, Mr. Norcross, Mr. Lawler, Mr. Ryan, 
Mrs. Kim, Mr. Goldman of New York, Mr. Van Orden, Mr. Landsman, and Mr. 
Fitzpatrick) introduced the following bill; which was referred to the 
Committee on Education and Workforce

_______________________________________________________________________

A BILL

To ensure coverage for the treatment of infertility for certain 
conditions.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Helping to Optimize Patients' 
Experience with Fertility Services Act'' or the ``HOPE with Fertility 
Services Act''.

SEC. 2. ENSURING BENEFITS FOR TREATMENT OF INFERTILITY AND IATROGENIC 
INFERTILITY.

(a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.) is amended by inserting after section 714 the following:

``SEC. 714A. STANDARDS RELATING TO BENEFITS FOR TREATMENT OF 
INFERTILITY AND IATROGENIC INFERTILITY.

``(a) In General.--A group health plan or a health insurance issuer 
offering group health insurance coverage shall ensure that such plan or 
coverage provides coverage for infertility or iatrogenic infertility 
treatments, including--
``(1) the treatment of infertility, if such plan or 
coverage provides coverage for obstetrical services; and
``(2) standard fertility preservation services when a 
medically necessary treatment described in subparagraph (A), 
(B), (C), or (D) of subsection (b)(1) causes, or is expected to 
cause, iatrogenic infertility.
``(b) Definitions.--In this section:
``(1) Iatrogenic infertility.--The term `iatrogenic 
infertility' means an impairment of fertility due to damage of 
reproductive organs and processes resulting from--
``(A) a surgical or other invasive medical 
procedure as a result of an injury or life-threatening 
illness, or involving a reproductive organ or process 
in a manner likely to cause damage to such organ or 
process;
``(B) radiation therapy;
``(C) chemotherapy; or
``(D) myeloablative conditioning.
``(2) Infertility.--The term `infertility' means a disease 
or condition characterized by--
``(A) the inability to achieve spontaneous 
pregnancy without medical treatment after a period of 
at least 12 consecutive months of unprotected sexual 
intercourse;
``(B) the inability to achieve pregnancy after 
receiving standard clinical treatment protocols under 
the supervision of a treating physician who is a board-
certified reproductive endocrinologist or obstetrician-
gynecologist;
``(C) being incapable of reproduction to live birth 
based on medical and reproductive history, age, 
physical findings or diagnostic testing of the 
individual, as determined by a treating physician; or
``(D) the inability to achieve spontaneous 
pregnancy on account of a diagnosed condition that is a 
disorder of ovulation, or a testicular or hormonal 
disease or disorder.
``(3) Infertility or iatrogenic infertility treatment.--The 
term `infertility or iatrogenic infertility treatment' means 
treatments or procedures with the intent of facilitating a 
pregnancy, including--
``(A) such treatments or procedures that involve 
the handling of human egg, sperm, and embryo outside of 
the body, including in vitro fertilization and 
maturation, egg and embryo cryopreservation, egg and 
embryo donation, and intracytoplasmic sperm injection; 
or
``(B) such treatments or procedures that do not 
involve the handling of human egg, sperm, and embryo 
outside of the body, including ovulation induction, 
genetic screening and diagnosis, sperm 
cryopreservation, and intrauterine insemination.
``(c) Required Coverage.--A group health plan and a health 
insurance issuer offering group health insurance coverage that includes 
coverage for obstetrical services shall provide comprehensive coverage 
for infertility or iatrogenic infertility treatments, as determined by 
the Secretary in consultation with relevant stakeholders, provided to a 
participant or beneficiary if--
``(1) the participant or beneficiary has infertility, 
including iatrogenic infertility; and
``(2) the treatment or service is performed at a medical 
facility that is in compliance with standards set by 
appropriate Federal and State agencies.
``(d) Financial Requirements and Treatment Requirements.--Any 
coverage provided by a group health plan or health insurance issuer in 
accordance with this section may be subject to coverage limits (such as 
medical necessity, pre-authorization, or pre-certification) and cost-
sharing requirements (such as coinsurance, copayments, and 
deductibles), as required under the group health plan or health 
insurance coverage, that are no more restrictive than the predominant 
coverage limits and cost-sharing requirements applied to substantially 
all medical and surgical benefits covered under the plan or coverage.
``(e) Prohibitions.--A group health plan and a health insurance 
issuer offering group health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a 
participant or beneficiary to encourage such participant or 
beneficiary not to be provided infertility or iatrogenic 
infertility treatments to which such participant or beneficiary 
is entitled under this section, or to providers to induce such 
providers not to provide such treatments to qualified 
participants and beneficiaries;
``(2) prohibit a provider from discussing with a 
participant or beneficiary infertility or iatrogenic 
infertility treatments or medical treatment options required to 
be covered under this section; or
``(3) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider provided 
infertility or iatrogenic infertility treatment services to a 
participant or beneficiary in accordance with this section.
``(f) Rule of Construction.--Nothing in this section shall be 
construed to--
``(1) require a participant or beneficiary in a group 
health plan or group health insurance coverage to undergo 
infertility or iatrogenic infertility treatments;
``(2) impact the use by a group health plan or a health 
insurance issuer offering group health insurance coverage of 
utilization management tools; or
``(3) prevent a group health plan or a health insurance 
issuer offering group health insurance coverage from 
contracting with providers as to the level and type of 
reimbursement with a provider for care provided in accordance 
with this section.
``(g) Utilization Management Tools Requirements.--
``(1) In general.--In the case of a group health plan or a 
health insurance issuer offering group health insurance 
coverage that imposes utilization management tools on 
infertility and iatrogenic infertility treatment benefits, for 
the first 5 plan years that begin after the date of enactment 
of the Helping to Optimize Patients' Experience with Fertility 
Services Act, such plan or issuer shall perform and document 
analyses of the design and application of the utilization 
management tool such analysis and the following information:
``(A) The specific plan or coverage terms or other 
relevant terms regarding the utilization management 
tools and a description of all infertility or 
iatrogenic infertility treatment benefits, to which 
each such term applies in each respective benefits 
classification.
``(B) The factors used to determine that the 
utilization management tool will apply to infertility 
or iatrogenic infertility treatment benefits.
``(C) The evidentiary standards used for the 
factors identified under subparagraph (B), when 
applicable, provided that every factor shall be 
defined, and any other source or evidence relied upon 
to design and apply the utilization management tool to 
infertility and iatrogenic infertility treatment 
benefits.
``(D) An analysis demonstrating that the processes, 
strategies, evidentiary standards, and other factors 
used to apply the utilization management tools to 
infertility and iatrogenic infertility treatment 
benefits as written and in operation, are consistent 
with, and are applied no more stringently than with 
clinical guidelines for infertility or iatrogenic 
infertility treatments.
``(E) The specific findings and conclusions reached 
by the group health plan or health insurance issuer 
with respect to the health insurance coverage, 
including any results of the analyses described in this 
paragraph that indicate that the plan or coverage is or 
is not in compliance with this section.
``(2) Submission process.--
``(A) Annual submission.--A group health plan or 
health insurance issuer offering group health insurance 
coverage shall submit to the Secretary the analyses 
described in paragraph (1) annually for first 5 plan 
years that begin after the date of enactment of the 
Helping to Optimize Patients' Experience with Fertility 
Services Act. For subsequent plan years, the Secretary 
may request that a group health plan or a health 
insurance issuer offering group health insurance 
coverage submit the analysis described in paragraph (1) 
in the case of potential violations of this section or 
complaints regarding noncompliance with this section 
that concern utilization management tools and any other 
instances in which the Secretary determines 
appropriate.
``(B) Additional information.--If the Secretary 
concludes that a group health plan or health insurance 
issuer has not submitted sufficient information for the 
Secretary to review the analysis described in paragraph 
(1), the Secretary shall specify to the plan or issuer 
the information the plan or issuer is required to 
submit pursuant to subparagraph (A). Nothing in this 
subparagraph shall require the Secretary to conclude 
that a group health plan or health insurance issuer is 
in compliance with this section solely based upon the 
inspection of the analyses described in paragraph (1), 
as requested under subparagraph (A).
``(3) Required action.--
``(A) In general.--If, after review of the analyses 
described in paragraph (1), the Secretary notifies the 
group health plan or health insurance issuer that such 
plan or issuer is not in compliance with this section, 
the plan or issuer--
``(i) shall specify to the Secretary the 
actions the plan or issuer will take to be in 
compliance with this section and provide to the 
Secretary additional analyses described in 
paragraph (1) that demonstrate compliance with 
this section not later than 45 days after the 
initial notification by the Secretary that the 
plan or issuer is not in compliance; and
``(ii) following the 45-day corrective 
action period under clause (i), if the 
Secretary makes a final determination that the 
plan or issuer still is not in compliance with 
this section, not later than 7 days after such 
determination, shall notify all individuals 
enrolled in the applicable plan or health 
insurance coverage that such plan or coverage 
has been determined to be not in compliance 
with this section.
``(B) Exemption from disclosure.--Documents or 
communications produced in connection with the 
Secretary's recommendations to a group health plan or 
health insurance issuer shall not be subject to 
disclosure pursuant to section 552 of title 5, United 
States Code.
``(4) Report.--For plan years beginning on or after January 
1, 2027, the Secretary shall submit to Congress, and make 
publicly available, a report that contains--
``(A) a summary of the analysis submitted under 
paragraph (1), including the identity of each group 
health plan or health insurance issuer offering health 
insurance coverage that is determined to be not in 
compliance after the final determination by the 
Secretary described in paragraph (3)(A)(ii);
``(B) the Secretary's conclusions as to whether 
each group health plan or health insurance issuer 
submitted sufficient information for the Secretary to 
review the analysis under paragraph (2);
``(C) for each group health plan or health 
insurance issuer that did submit sufficient information 
under paragraph (2), the Secretary's conclusions as to 
whether and why the plan or issuer is in compliance 
with the requirements under this section;
``(D) the Secretary's specifications described in 
paragraph (3) for each group health plan or health 
insurance issuer that the Secretary determined did not 
submit sufficient information for the Secretary to 
review the analyses described in paragraph (1) for 
compliance with this section; and
``(E) the actions the Secretary specifies under 
paragraph (3)(A)(i) that each group health plan or 
health insurance issuer that the Secretary determined 
is not in compliance with this section is required take 
to be in compliance with this section, including the 
reason why the Secretary determined the plan or issuer 
is not in compliance.
``(h) Notice.--Beginning with the second plan year beginning after 
the date of enactment of the Helping to Optimize Patients' Experience 
with Fertility Services Act, a group health plan and a health insurance 
issuer offering group health insurance coverage shall provide notice to 
participants and beneficiaries in such plan or coverage regarding the 
coverage required by this section in accordance with regulations 
promulgated by the Secretary.
``(i) Effective Date.--This section, and the amendments made by 
this section, shall apply with respect to plan years beginning on or 
after January 1, 2027.''.
(b) Enforcement.--Section 502 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1132) is amended--
(1) in subsection (a)(6), by striking ``or (9)'' and 
inserting ``(9), or (13)'';
(2) in subsection (b)(3), by striking ``subsection (c)(9)'' 
and inserting ``paragraphs (9) and (13) of subsection (c)''; 
and
(3) in subsection (c), by adding at the end the following:
``(13)(A) The Secretary may assess a civil penalty against a health 
insurance issuer for failing to provide coverage for infertility or 
iatrogenic infertility treatments as required under section 714A, in an 
amount up to $100 per day, beginning on the date on which the issuer 
first denies such coverage and ending on the date on which the issuer 
approves coverage, with respect to each participant or beneficiary 
denied such coverage in violation of such section.
``(B) The Secretary may assess a civil penalty against a health 
insurance issuer for failing to submit an analysis as required under 
section 714A(g)(2), in an amount up to $100 for each day, beginning 45 
days after the date on which the Secretary notifies such issuer that 
the issuer is not in compliance with the requirement under section 
714A(g)(2), and ending on the date on which the issue submits the 
analysis as required.''.
(c) Conforming Amendment.--Section 731(c) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1191(c)) is amended 
by striking ``section 711'' and inserting ``sections 711 and 714A''.
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