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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
Supplemental Maternity Insurance If you are pursuing any type of infertility treatment, it pays to remember your primary objective is to get pregnant. Infertility insurance is great to have, but if mom misses extended time away from work due to complications of her pregnancy, you might find your growing family is in a financial bind. Buy supplemental maternity insurance before starting any ART procedure.
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Who is Covered by the MD 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.
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?
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.
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 Mandated Health Benefits
