Maryland Infertility Mandate
Maryland Infertilty and IVF Health Insurance Law
Maryland infertility and IVF health insurance is mandated by state law.
Who is Covered by the MD Mandate?
The Maryland infertility insurance mandate does not cover every resident. The mandate lists a number of population segments that do not need to comply.
Individual policies, and policies sold to groups of fewer than fifty employees are exempt from the Maryland mandate.
HMO's are also required to comply if they provide hospital, medical, or surgical benefits. Coverage for IVF must be provided on the same basis as other fertility services. This leaves one loophole: what happens if your HMO does not cover other fertility services? You may not have coverage.
Group policies issued in other states are exempt. This is quite common for any state insurance mandates. The state insurance laws where a plan is issued govern. Many employers with workers in Maryland may be headquartered in another state. You would need to determine the situs state for your health plan to determine what state infertility mandates, if any, apply to your group plan.
Federal government workers enrolled in a government health plan are exempt from the mandate. Maryland has a large population of government workers who do not benefit from the infertility mandate.
Self-funded and self-insured plans are quite common with larger employers. Since these plans are not technically health insurance as defined by law, the plans are exempt from the mandate.
Medicare, Medicaid, and Children’s Health Insurance Plans (CHIP) are also exempt.
Wait Two Years for IVF Coverage?
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.
For those who don't want to wait consider this:
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:
Maryland and Male Infertility
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.