Montana Law Mandating Infertility Coverage

The Montana infertility insurance law stipulates that preventative infertility services are to be covered if the couple experiences an inability to conceive purely as a result of infertility problems (unexplained infertility, for example).  Experimental procedures - determined on a case-by-case basis by the Insurance Department --are not covered.

In Vitro Fertilization (IVF) is not consdered a preventative service, and hence not subject to this mandate. 

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.

Get interest free fertility treatment & IVF financing through your flexible spending account.  Your annual election is available on the first day of your plan year for eligible expenses such as your IVF procedure, and other infertility treatments.

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 Montana infertility law addresses HMO's only.  If your insurance plan is considered an HMO, Montana's law requires your plan to cover basic preventive health services, including infertility.  Confirm coverage with your employer before beginning infertility treatments.

Consider using supplemental infertility insurance coverage to fund your maternity leave, and protect your income in case of complications, and/or premature birth.

The Montana infertility insurance rules have many exceptions once you take a closer look. The law can only be enforced when Montana has jurisdiction to regulate.  If your employer is headquartered in another state, your health plan may not be subject to this mandate.

The law regulates HMO's, not employers.  If you work for a large employer that self insures, you may not be covered. 

If your plan is a Preferred Provider Plan (PPO), Point of Service plan (POS), or traditional fee for service plan, chances are your infertility treatments are not covered. Check with your HR department before undergoing infertility treatments.