Illinois Infertility & IVF Health Insurance Coverage

Illinois infertility and IVF health insurance is mandated by state law. The Illinois infertility health insurance law mandates that employers with 25 or more employees offer coverage.

But the law has limitations, and not all Illinois residents and workers are covered.  Discover what is covered, who the law applies to, and how to cut costs for infertility and IVF treatments. Infertility coverage is one of three main considerations for a growing family:

1. Coverage that pays infertility treatments, fertility drugs, etc
   
2. Benefits for your resulting pregnancy and hospitalization
   
3. Replace your income during maternity leave and in case of high risk pregnancy
   

Be sure to consider all three.

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.

The Illinois Infertility Insurance Mandate requires that certain infertility treatments be covered, but it does not stipulate the level of coverage.  The law does require insurers to cover the diagnosis and treatment of infertility the same as any other condition. 

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.  You may even get an interest free loan!

The Illinois Infertility Insurance law covers employers with more than 25 employees. So if you work for a larger employer headquartered in Illinois, chances are you will be covered. Confirm coverage with your employer before beginning infertility treatments.

The Illinois Infertility Insurance rules have many exceptions once you take a closer look. The law can only be enforced when the Illinois State Insurance Department has jurisdiction to regulate. If your employer is headquartered in another state, your employer is not subject to the Illinois rules, it must comply to that state's infertility mandate.

HMO's may be required to follow the mandate if the HMO maintains a provider network in the state of Illinois.

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. Employers with less than 25 employees are not subject to this law.