Fourteen states have passed infertility insurance laws which mandate coverage in one capacity or another. Two states simply require that insurers offer the coverage, while the remaining twelve mandate that specific employer groups include infertility treatment coverage.
Even if you live in one of the states mandating coverage, and your employer is subject to the regulation, you still may find yourself facing large out of pocket costs for your infertility treatments. Plus, many couples living in states with mandates find they fall into one of many loopholes in the laws. Read below for a summary of the mandates. Click the links to learn more.
Arkansas
This law requires all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF). Health maintenance organizations, commonly called HMOs, are exempt from the law. Patients need to meet specific conditions in order to get their IVF covered.
California
The California Infertility Insurance Law requires certain insurers to offer coverage for infertility diagnosis and treatment. That means group health insurers covering hospital, medical or surgical expenses must let employers know infertility coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their employee insurance plans.
Connecticut
The Connecticut infertility insurance law requires that individual and group health insurance policies are cover medically necessary expenses for infertility diagnosis and treatment. Covered treatments include ovulation induction, interuterine insemination, IVF, uterine embryo lavage, embryo transfer, GIFT, ZIFT, and low tubal embryo transfer. Coverage is limited to individuals who have maintained coverage under the policy for at least a year.
Hawaii
The Hawaii law requires certain insurance plans to provide a one-time only benefit for outpatient costs resulting from in vitro fertilization. Those plans include individual and group health insurance plans, hospital contracts or medical service plan contracts that provide pregnancy-related benefits. Patients need to meet specific conditions in order to get their IVF covered.
Illinois
The Illinois Infertility Insurance Coverage Law requires insurance policies that cover more than 25 people and provide pregnancy-related benefits to cover costs of the diagnosis and treatment of infertility.
Maryland
The Maryland law requires health and hospital insurance policies issued or delivered in Maryland that provide pregnancy-related benefits to also cover the outpatient costs of in-vitro fertilization. HMO's must provide IVF benefits to the same extent as the benefits provided for other infertility services.
Massachusetts
The Massachusetts infertility insurance law requires health maintenance organizations and insurance companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment. The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."
Montana
This state's law requires health maintenance organizations to cover infertility services as part of basic preventive health care services. The law does not define infertility or the scope of services covered; nor did the state ever draft regulations explaining what infertility services entail.
New Jersey
The New Jersey Infertility mandate - The Family Building Act requires insurance policies that cover more than 50 people and provide pregnancy-related benefits to cover the cost of the diagnosis and treatment of infertility.
New York
The New York Infertility Insurance Law requires insurers to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York are required to provide coverage infertility for patients between the ages of 21 and 44.
Ohio
Ohio's Infertility Insurance Law requires health maintenance organizations to cover basic preventive health services, including infertility. Experimental procedures are not covered.
Rhode Island
The Rhode Island Infertility Insurance Law requires insurers and HMO's that cover pregnancy services to cover the cost of medically necessary expenses of diagnosis and treatment of infertility for women between the age of 25 and 42. The patient's co-payment cannot exceed 20 percent.
Texas
The Texas infertility insurance law mandates insurers that cover pregnancy services to offer coverage for in vitro fertilization. That means insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans.
West Virginia
West Virginia's law requires health maintenance organizations to cover basic health care services, including infertility services, when medically necessary.
