Infertility, usually defined as being unable to conceive after one year of unprotected sex is a common affliction. An affliction that affects approximately 1 and 8 couples in the US alone. In order to combat their fertility problems couples turn to doctors for treatments such as in vitro fertilization (IVF), where the women’s eggs are surgically removed, fertilized with the designated sperm in the laboratory and then the resulting embryos are transferred back into the uterus; or intrauterine insemination (IUI), where the partner’s or, in some cases, the donor sperm is processed and injected into the uterus during ovulation.
State Infertility Laws
There are approximately 15 states that have passed legislation addressing the issue of insurance companies covering infertility treatments. I have summarized the states with their individual infertility legislative below. Be aware that each state has their own definition of infertility, which you must meet in order to qualify for any benefits. It is also common to allow certain religious organizations and/or employers to be exempt from having to provide infertility coverage.
Arkansas: require health insurance companies to cover services and procedures performed at properly licensed facilities; the Arkansas Comprehensive Health Insurance Pool shall not be used for any infertility related procedures.
California: requires health insurance to offer insurance coverage for the treatment of infertility, but not IVF.
Connecticut: requires that health insurance provide coverage for medically necessary expenses in the diagnosis and treatment of infertility, including in vitro fertilization procedures, Except where such coverage would go against the religious beliefs of an employer or individual.
Hawaii: require all accident and health insurance policies that provide pregnancy-related benefits to also include a one-time only benefit for outpatient expenses arising from in vitro fertilization procedures.
Illinois: requires certain insurance policies that provide pregnancy-related benefits to provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization (IVF). Coverage is limited to four completed egg retrievals( IVF cycles), except if a live birth follows a completed IVF cycle, then two more IVF cycles are covered.
Louisiana: prohibits the exclusion of coverage for the diagnosis and treatment of a medical condition otherwise covered by the policy, contract, or plan, solely because the condition results in infertility. The law does not require insurers to cover fertility drugs, in vitro fertilization or other assisted reproductive techniques, reversal of a tubal litigation, a vasectomy, or any other method of sterilization.
Maryland: Infertility coverage is required for all insurance policies, with several conditions regulating when the coverage kicks in, and stipulates the insurer may impose a maximum lifetime benefit of $100k or three IVF cycles. Small businesses with under 50 employees, or certain religious organizations are exempt from having to provide IVF coverage.
Massachusetts: require general insurance policies, non-profit hospital service corporations, medical service corporations and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization.
Montana: revises certain requirements of Montana’s Comprehensive Health Association, the state’s high-risk pool, and clarifies that covered expenses do not include charges for artificial insemination or treatment for infertility. They also requires health maintenance organizations to provide basic health services on a prepaid basis, which include infertility services. Other insurers are exempt from having to provide the coverage.
Minnesota:specifies that medical assistance shall not provide coverage for fertility drugs when specifically used to enhance fertility.
New Jersey: require health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility, including medications, surgery, in vitro fertilization, embryo transfer, artificial insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection and four completed egg retrievals per lifetime of the covered person. The law includes some restrictions as well as a religious exemption for employers that provide health coverage to fewer than 50 employees.
New York: prohibit individual and group health insurance policies from excluding coverage for hospital care, surgical care and medical care for diagnosis and treatment of correctable medical conditions otherwise covered by the policy solely because the medical condition results in infertility. The laws exclude coverage for in vitro fertilization.
Ohio: requires health maintenance organizations (HMOs) to provide basic health care services, which include infertility services, when medically necessary.
Rhode Island: require any contract, plan or policy of health insurance (individual and group), nonprofit hospital service, nonprofit medical service and health maintenance organization to provide coverage for medically necessary expenses for the diagnosis and treatment of infertility. The also law clarifies that the co-payments for infertility services not exceed 20 percent.
Texas: requires that all health insurers offer and make available coverage for services and benefits for expenses incurred or prepaid for outpatient expenses that may arise from in vitro fertilization procedures. Certain conditions need to be met before infertility coverage is allowed. The law includes exemptions for religious employers.
West Virginia: amends the 1997 law and requires health insurers to cover basic health care services, which include infertility services. Applies to health maintenance organizations (HMOs) only
Each state has different definitions of infertility and you must meet the specific requirement set forth by each state with IVF coverage in order to qualify for the benefit. If you are happen to live in a state that has mandatory insurance coverage for IVF I recommend calling your insurance company for the latest information on what the specific requirements are to qualify for your infertility benefit. For more information on the statues summarized above check out the National Congress of State Legistatures.
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