Arkansas Law Mandating IVF Coverage

The Arkansas law mandates the all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF) up to a lifetime maximum of $15,000. Patients need to meet specific conditions in order to get their IVF covered.  

• You must be the policyholder or spouse of the policyholder
• The patients eggs must be fertilized with her husband's sperm
• You must have at least a two year history of infertility

The Arkansas IVF mandate has several clauses that bear close scrutiny to understand who the law may actually cover. The rules applies to residents of Arkansas regardless of where the policy or contract was issued. If your employer is headquartered out of state, the mandate apparently applies. Health insurance is regulated on a state level, and typically plans issued in other states must comply with the rules in the In Situs state only. If your employer has only a handful of employees in Arkansas, chances are they are unaware of this requirement. You may need a good attorney to help sort this out.

Larger companies headquartered in the state may self insure and may not be required to comply. The law applies to “individual, group or blanket disability insurance policies”. Self insuring employers do not fit this description. Large employers who might self insure include: Walmart, Murphy Oil, Tyson Foods, Alltell Communications, Dillards, JB Hunt, Windstream, and others may be exempt.

The key phrase in the legal language for this law is “which provide normal pregnancy-related benefits”. Not every health plan covers normal pregnancy unless compelled by a separate law. Arkansas has no corresponding requirements for individual or small group health plans to cover normal pregnancy. Without such a mandate insurers can escape this requirement by focusing only on plans that exclude normal pregnancy. A plan with a maternity rider might have to comply. Groups with 15 or more employees are required to cover normal pregnancy by the Pregnancy Discrimination Act. It appears that only this segment will need to comply.

In Vitro Fertilization (IVF) is often the last line of treatment for couples trying to conceive. Many other treatments including fertility drugs, artificial insemination, and more are not subject to this regulation.

In addition the Arkansas mandate stipulates that a patient must have two years of unexplained infertility. That poses a difficult choice for couples trying to conceive:

• Should we pay for other infertility treatments ourselves right away?
• Should we wait two years and go straight for IVF even though other treatments may work?

For those who don't want to wait consider this:

• Cut your infertility costs by leveraging the tax code and flexible spending accounts. 
• Use supplemental health insurance to create income from your normal delivery to offset your infertility treatment costs, and get additional security for complications.

In order to qualify for benefits you must meet the infertility definition stipulated in the law.

• You must be the policyholder or the policyholder’s spouse. Unmarried couples, civil union partners and gay and lesbian couples may be excluded.
• The woman’s oocytes must be fertilized with the spouse’s sperm. This excludes lesbian couples regardless of any gay marriage rules.
• The couple must have a two year history of unexplained infertility
• Couples with diagnosed infertility may be covered if due to
  • Endometriosis 
  • Exposure in utero to Diethylstilbestrol - a drug once prescribed during pregnancy to prevent miscarriages or premature deliveries
  • Blockage or removal of one or more fallopian tubes - voluntary sterilizations (tubal ligation) do not count
  • Abnormal male factors

The IVF procedures must be performed at a facility certified by the Arkansas Department of Insurance to comply with standards set by the American College of Obstetricians and Gynecologists or the American Fertility Society.

Source: Arkansas Rule and Regulation 1 In Vitro Fertilization