Rhode Island Infertility Mandate
Rhode Island Infertility& IVF Insurance Law
Rhode Island infertility and IVF insurance is available to some state residents.
The Rhode Island infertility health insurance law mandates that any health insurance contract, plan, or policy delivered or issued for delivery or renewed in Rhode Island, which includes pregnancy related benefits, shall provide coverage for medically necessary expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42) years.
Before beginning any infertility protocol make sure you understand:
Rhode Island Infertility Insurance - Who is Covered?
The Rhode Island infertility law covers employers of all sizes - unlike in other states. But that does not translate automatically into every plan having infertility coverage. The RI regulation applies to any policy “which includes pregnancy related benefits”. If your plan does not include pregnancy related benefits, it might be exempt from the requirement.
RI Infertility Insurance Mandate - Where are the Holes?
The Rhode Island infertility insurance law requires that infertility treatments be covered. Lifetime benefits are capped at $100,000, and the law allows for 20% co-insurance. In other words, you may be faced with $20,000 of out-of-pocket expenses, or much more. There are a variety of ways the “or more” portion may play out.
If you consume the entire lifetime benefit, your plan may ask you to pay 20% of the “allowed charges” or up to $20,000. That part is most obvious. You may consume the entire benefit, and want to continue trying to get pregnant. 100% of the expenses are then your responsibility. Five IVF cycles could get you to this number.
Your infertility clinic may be out of network. Your plan pays for the allowed charges, but an out of network clinic charges whatever it wants. You are responsible for the difference between the clinic fees, and what your plan allows.
You may be taking fertility drugs. Insurance companies publish formularies - lists of prescription drugs which it will cover. If your doctor prescribes a drug not on your insurers formulary, you must pay the amount out of your pocket.