Connecticut infertility and IVF health insurance is mandated by state law. The Connecticut infertility health insurance law mandates that "certain individual and group health policies to cover medically necessary costs of diagnosing and treating infertility". Before beginning any infertility treatment understand exactly how this law works:
- Who is covered
- What infertility treatments are mandated and how?
- Where are the holes?
Connecticut Infertility Insurance - Who is Covered?
The Connecticut infertility and IVF insurance mandate is quite broad.
The Connecticut act is
"applicable to individual and group health policies that cover basic
hospital expenses; basic medical surgical expenses; major medical
expenses; hospital or medical service plans contracts; and, hospital and
medical coverage provided to subscribers of a health care center that
are delivered, issued, amended, renewed or continued on or after October
1, 2005".
The Connecticut infertility health insurance law defines infertility as "the
condition of a presumably healthy individual who is unable to conceive
or produce conception or sustain a successful pregnancy during a one
year period".
CT Infertility Insurance: Who is Not Covered?
Connecticut infertility and IVF insurance is not automatically available to every CT resident.
The law can only be enforced when Connecticut has jurisdiction to regulate. If your employer is headquartered in another state, your health plan may not be subject to this mandate. If you commute into New York or Massachusetts then your insurance plan may be regulated by those state laws. Check the laws for the state where your employer is headquartered.
The law regulates health insurance companies, not employers. If you work for a large employer that self insures, you may not be covered. Check with your HR department before undergoing infertility treatments. The Connecticut law also applies only to women up to age 40.
Connecticut Infertility Insurance - Covered Treatments
The Connecticut Infertility Insurance Act provides that covered medically necessary expenses of the diagnosis and treatment of infertility include, but are not limited to:
- Ovulation induction up to 4 cycles
- Intrauterine insemination (IUI) up to 3 cycles
- In-vitro fertilization (IVF) up to 2 cycles with a maximum of 2 embryos per cycle
- Uterine embryo lavage
- Embryo transfer
- Gamete intra-fallopian transfer (GIFT)
- Zygote intra-fallopian transfer (ZIFT)
- Low tubal ovum transfer
Connecticut Infertility Insurance - Where are the Holes?
The Connecticut infertility
insurance law requires that certain infertility treatments be covered,
but it does not stipulate the level of coverage. Every insurance plan
leaves you with some level of unreimbursed expenses. Things like
co-pays, co-insurance, and out of network charges can add up very
quickly. For example:
- Some prescription drug plans
provide 50% reimbursement. The other 50% of your fertility drug costs
are yours.
- Co-insurance, the amount of
allowed charges that are your responsibility may run to 20% to 30%.
- Out of network fees may come
into play if your fertility clinic of choice is not in network with your
plan. You will be responsible for the amounts over and above what the
insurance company reimburses as usual customary and reasonable.
Cut your infertility treatment
costs by 1/3 or more by using your flexible spending account to pay for
un-reimbursed infertility treatment expenses.
Get interest free fertility
treatment financing through your flexible spending account.
Your
annual election is available on the first day of your plan year for
eligible expenses such as your IVF procedure, and other infertility
treatments.
