Maryland Infertilty and IVF Health Insurance Law

Maryland infertility and IVF health insurance is mandated by state law. 

The Maryland law mandates that all health insurers that provide pregnancy related benefits to cover the out-patient treatment cost of in vitro fertilization (IVF) to the same extent as other pregnancy related services. Health maintenance organizations (HMO) must cover IVF to the same extent as other infertility treatments.

The Maryland infertility and IVF health insurance law has some interesting quirks that couples need to understand and address:

• Coverage does not apply to every resident - see who is covered
• There is a two year waiting period for IVF insurance coverage 
  • How do you pay for 2 years of infertility treatment costs before trying IVF?  
  • Can you wait that long to start your family?
  • Some exceptions apply

The Maryland infertility insurance mandate does not cover every resident - even with unique features.

Unlike other states with infertility coverage mandates the Maryland law goes a step further: it applies to people living and working in Maryland, regardless of whether the policy is issued outside of Maryland.  If you work for an out-of-state employer your health insurance policy was probably issued in another state and must comply with those state insurance mandates - in addition to the MD rule. Your employer and/or your insurer might overlook this rule. Check your policy carefully for compliance.

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.

You must have been unsuccessful in getting pregnant using less costly infertility treatments for which coverage was available under the policy. Since the mandate does not require coverage for other treatments, this clause may not apply to many couples. In addition the Maryland mandate stipulates that a patient must have two years of unexplained infertility.

The waiting period is waived if the inability to conceive is caused by:

• Endometriosis
• Exposure in utero to diethylstilbestrol (DES)
• Blockage of one or both fallopian tubes
• Abnormal male factors

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

• Cut costs using tax deductible infertility expenses and flexible spending accounts.
• Use supplemental maternity insurance to create income from your normal delivery to offset your infertility treatment costs, and get additional security for complications.

This raises a few questions. What if your policy does not cover infertility, or you don't suffer from one of the conditions listed above? You don't have to try less expensive treatments, but you still have to wait two years. This then 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?

The Maryland IVF insurance law stipulates that the egg must be fertilized by the patient's spouse. This rule may have been included to limit IVF access for same sex couples, but it also impacts a large group of mainstream couples as well: those with male factor infertility.

Male factor infertility is a sole or contributing cause in 40% of infertile couples. The husband may have difficulty generating healthy sperm or sperm capable of fertilizing an egg. Couples dealing with male infertility may have partial relief from the Maryland IVF insurance mandate.

The mandate specifically allows couples coping with male infertility to proceed directly to IVF benefits, citing oligospermia (low sperm count) as a qualified condition. If the husband’s sperm are not healthy enough to fertilize an egg, then what do you do? The mandate excludes fertilization from another man. These couples are left with few options.

Sources: MD Insurance Section 15-810 and MD Consumer Guide to Health Insurance