Montana Law Mandating Infertility Coverage

The Montana infertility health insurance law mandates that Health Maintenance Organizations (HMO) provide coverage for diagnosis and treatment of infertility. But the law has limitations, and not all residents and workers are covered. Discover what is covered, who the law applies to, and how to cut costs for IVF and other infertility treatments.

Infertility coverage is one of three main considerations for a growing family:

• Coverage that pays fertility treatments, drugs, etc
• Benefits for your resulting pregnancy and hospitalization
• Income replacement during your maternity leave and in case of complications

​Be sure to consider all three.

The Montana infertility insurance law stipulates that Health Maintenance Organizations (HMO) must provide “basic health care services”. The law goes on to clarify what is meant by this language. Some definitions of note for couples trying to conceive include:

• Inpatient hospital and provider care - vital when you deliver your baby
• Accident and sickness coverage to each newborn infant of an enrollee - very important for your baby is born prematurely or is seriously ill
• Preventive services which may include:
  • Well child care from birth
  • Family planning services
  • Infertility services

This language begs the question: “What exactly is a preventive infertility service?” The Montana law does not explain. If you are a member of an HMO the best option is to read your health plan summary of benefits, and call your insurance company to clarify what procedures are covered, and for how much.

The MT mandate does provide specific language exempting “Association Plans” from having to cover:

• Routine well baby care
• Complications to a newborn unless no other coverage is available
• Reversal of sterilizations
• Abortion unless the mother’s life is in jeopardy
• Artificial insemination
• Treatment for infertility

Not every Montana worker or resident is covered by the mandate. Even if you are enrolled in an HMO if the plan was issued out of state the mandate may not apply. The law can only be enforced when Montana has jurisdiction to regulate, and most group health plan are regulated by the In Situs State - usually your employer’s headquarter state. Most states have no laws regarding infertility services.

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.

Source: Montana Code Annotated: 33-22-1521, 33-31-102