1374.55
. (a) On and after January 1, 1990, every health care
service plan contract that is issued, amended, or renewed that covers
hospital, medical, or surgical expenses on a group basis, where the
plan is not a health maintenance organization as defined in Section
1373.10, shall offer coverage for the treatment of infertility,
except in vitro fertilization, under those terms and conditions as
may be agreed upon between the group subscriber and the plan. Every
plan shall communicate the availability of that coverage to all group
contractholders and to all prospective group contractholders with
whom they are negotiating.
(b) For purposes of this section, "infertility" means either (1)
the presence of a demonstrated condition recognized by a licensed
physician and surgeon as a cause of infertility, or (2) the inability
to conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment of
infertility by licensed physicians and surgeons including, but not
limited to, diagnosis, diagnostic tests, medication, surgery, and
gamete intrafallopian transfer. "In vitro fertilization" means the
laboratory medical procedures involving the actual in vitro
fertilization process.
(c) On and after January 1, 1990, every health care service plan
that is a health maintenance organization, as defined in Section
1373.10, and that issues, renews, or amends a health care service
plan contract that provides group coverage for hospital, medical, or
surgical expenses shall offer the coverage specified in subdivision
(a), according to the terms and conditions that may be agreed upon
between the group subscriber and the plan to group contractholders
with at least 20 employees to whom the plan is offered. The plan
shall communicate the availability of the coverage to those group
contractholders and prospective group contractholders with whom the
plan is negotiating.
(d) This section shall not be construed to deny or restrict in any
way any existing right or benefit to coverage and treatment of
infertility under an existing law, plan, or policy.
(e) This section shall not be construed to require any employer
that is a religious organization to offer coverage for forms of
treatment of infertility in a manner inconsistent with the religious
organization's religious and ethical principles.
(f) (1) This section shall not be construed to require any plan,
which is a subsidiary of an entity whose owner or corporate member is
a religious organization, to offer coverage for treatment of
infertility in a manner inconsistent with that religious organization'
s religious and ethical principles.
(2) For purposes of this subdivision, "subsidiary" of a specified
corporation means a corporation more than 45 percent of the voting
power of which is owned directly, or indirectly through one or more
subsidiaries, by the specified corporation.
(g) Consistent with Section 1365.5, coverage for the treatment of
infertility shall be offered and, if purchased, provided without
discrimination on the basis of age, ancestry, color, disability,
domestic partner status, gender, gender expression, gender identity,
genetic information, marital status, national origin, race, religion,
sex, or sexual orientation. Nothing in this subdivision shall be
construed to interfere with the clinical judgment of a physician and
surgeon.