Illinois Infertility Mandate
Illinois Infertility & IVF Health Insurance Law
Illinois infertility and IVF health insurance is mandated by state law. The law mandates that insurers must provide coverage to employer groups with 25 or more employees. But the law has limitations, and not all Illinois residents and workers are covered. Discover:
When investigating laws look beyond infertility procedures to the resulting pregnancy, and maternity leave. Illinois laws do not replace mom's income, an important consideration for couples trying to conceive - no matter what your insurance plan pays for your infertility or IVF procedures.
Illinois Groups Subject to Mandate
The Illinois infertility insurance law applies to employers with more than 25 employees. The mandate does not apply to trusts, groups that self insure, group policies issued in another state, or religious organizations.
Individuals Covered by IL Mandate
The IL infertility law provides detailed qualifications. The mandate applies to a woman who is not able to:
She may also qualify if she has been:
What is most interesting is that male infertility factors are not included in the list. Since the male accounts for 40% to 50% of infertility cases, this represents a significant hole in the mandate. Almost half of all couples may have to pay for infertility treatments themselves if the man is dealing with low sperm count, misshapen or immobile sperm, or blockages in seminal vesicles.
What Infertility Procedures are Covered?
The Illinois Infertility Health Insurance mandate is a law that requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility including:
Unlimited IVF in Illinois?
The Illinois law has two very interesting features relating to Artificial Reproductive Techniques (ART) requiring oocyte retrievals. First there is the variable limit of oocyte retrievals based upon whether you deliver a baby or not, and the second provides for an unlimited number of procedures to transfer the embryos back.
There is a limit of six retrievals per lifetime. This limit includes any retrievals another insurance carrier covered, or you paid for yourself. In order to reach the six oocyte benefit level you must demonstrate they work. The first limit is three. If you fail to deliver a baby your benefits cease. If you are able to deliver a baby, two more oocyte retrievals are now available to be covered.
The unlimited number of procedures to transfer back embryos makes for an interesting cost/benefit suggestion. “One completed oocyte retrieval could result in many IVF, GIFT, ZIFT or ICSI procedures.” Fertility drugs are a covered benefit, and stimulate egg production. This benefit might encourage couples to maximize egg production. Egg storage costs are not included in the mandate, but fees are relatively small compared to the other covered benefits.
Do you get the picture? The very expensive components are covered with no limits. Make the most of each retrieval, and store those eggs. The payback is enormous!
Infertility Procedures Not Covered
The Illinois law has procedures that are excluded by commission and by omission. The procedures specifically excluded include:
Illinois Infertility and IVF - Supplemental Insurance
You may find that your employer does offer health insurance with infertility coverage. And even if they do, you may find that you still have many left over bills. Be sure to take full advantage of our cost saving opportunities, and fund your maternity leave by purchasing supplemental health insurance before getting pregnant.