Health Insurance Coverage Of Infertility Treatment
Deciding on fertility treatments can be a challenging and difficult step for many couples. Not only are fertility treatments physically demanding, but they can also be very taxing on your emotions. Additionally, the cost of fertility treatments can be very high, and a decision to try certain procedures could impact greatly on your financial future. Many couples wonder if health insurance policies will cover the cost of some or all of their infertility treatments. While the majority of states do not require health insurers to cover infertility treatments, 13 states now mandate coverage of certain infertility treatments.
Does Health Insurance Cover Infertility Treatment?
Most health insurance policies do not cover the costs of infertility diagnosis and treatments. However, in recent years certain states have introduced laws requiring certain insurance providers to offer or cover specific fertility treatments. These laws are known as mandates. There are two types of mandates:
- Mandates to Offer: Mandates to offer require insurance companies to offer policies that cover infertility diagnosis and treatments. Employers must be made aware of these policies but are not required to include them in their employee benefits package.
- Mandates to Cover: Mandates to cover require insurance companies to cover the cost of certain fertility treatments in every policy. Monthly premiums help to cover the costs of these treatments.
States with Fertility Treatment Mandates
To date, 13 states have mandates to offer or cover fertility treatments.
Arkansas:
In Arkansas, health insurance companies are required to cover the cost of IVF treatments, up to a lifetime maximum of $15,000. These treatments must be performed in a facility that is licensed by the Arkansas Department of Health. Patients must meet certain requirements before receiving coverage. HMOs are exempt from this mandate.
California:
California law requires certain insurers to offer coverage for both infertility diagnosis and treatment. Group health insurers must inform employers of the availability of these policies, though laws do not require employers to offer such plans to their workers. This mandate excludes IVF treatment and allows companies with certain religious beliefs to be exempted.
Conneticut:
In Conneticut, individual and group health insurers are mandated to cover medically-necessary infertility procedures. This includes IVF, IUI, embryo transfer, GIFT, and ZIFT, up to a specific lifetime maximum. Patients must meet specific criteria before qualifying for treatment. Employers with opposing religious beliefs may opt out of the mandate.
Hawaii:
In Hawaii, certain insurance providers must offer policy holders a one-time benefit for IVF treatment costs already incurred. This includes both individual and group health insurers. Patients are required to meet specific qualifying criteria.
Illinois:
Illinois law mandates that policies covering more than 25 people and offering pregnancy benefits must cover the treatment and diagnosis of infertility. This includes the cost of IVF, embryo transfer, GIFT, ZIFT, and ICSI. The law exempts those employers who hold religous beliefs that oppose these treatments.
Maryland:
Maryland law requires health and hospital insurance providers that offer pregnancy benefits to cover the outpatient costs associated with IVF treatment. Treatments must be covered to a lifetime benefit of $100,000 or three IVF cycles. Religous organizations may be exempted by request.
Massachusetts:
Massachusetts law requires those HMOs and insurance companies covering pregnancy benefits to cover those medically-necessary costs of fertility treatment. This covers IVF, IUI, GIFT, ZIFT, and sperm and egg retrieval. This mandate does not include experimental procedures or the cryopreservation of eggs.
Montana:
In Montana, HMOs are required to cover all preventative health care services, including infertility treatment. However, the mandate does not define infertility nor does it describe the treatments that should be covered.
New Jersey:
New Jersey law requires that group policies covering 50 or more people, and covering pregnancy-related expenses, need to cover the cost of the diagnosis and treatment of infertility. This includes sugery, IVF, GIFT, ZIFT, ICSI, embryo transfer, and IUI. Up to a maxmimum of four egg retrievals can also be performed. Religious organizations may be exempt.
New York:
New York law mandates that private and group plans issued within the state cover the diagnosis and treatment of all correctable conditions, including infertility. Treatment must cover those between the ages of 21 and 44. Excluded treatments include IVF, GIFT, and ZIFT.
Ohio:
In Ohio, insurers are required to cover all basic preventative health care expenses, including infertility treatments. However, the mandate does not define infertility nor does it describe which procedures are covered. It does dictate that all procedures must be medically-necessary.
Rhode Island:
In Rhode Island, all insurers and HMOs that cover pregnancy-related expenses must cover the diagnosis and treatment of infertility. However, only those procedures that are medically-necessary will be covered.
Texas:
In Texas, those insurers that cover pregnancy benefits must offer coverage for IVF treatments. Employers must be informed of the availability of these policies, however, they do not have to include them in their employee benefits package. Companies with opposing religous beliefs can be exempt.
West Virginia:
HMOs in West Virgina must cover all basic health care services, including those related to infertility. However, the mandate does not define infertility, nor does it describe which treatments must be covered.
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