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.
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 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.
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.