Federal and State Infertility Insurance Laws
Federal and state infertility insurance laws are important to know no matter where you live. Most insurance plans will not cover infertility unless compelled by state law. Fifteen states have laws mandating some level of coverage, but these laws vary widely in term of who and what procedures are included. Loopholes and exceptions abound, and regulations work differently from what most people expect.
- Federal Health Care Reform - what the new law does for couples trying to conceive.
- Common Exemptions - religious organizations, companies that self insure, and smaller employers are often not required to comply
- In Situs State - mandates apply where the policy is issued; the key that most people miss
How to Find Infertility Coverage Understanding the federal and state laws regulating health insurance for infertility is one component in finding the coverage you want. But it does not stop with looking in your home state. Take what you learn here and apply it to your employment situation. Make an informed decision the could impact your family for years to come.
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Healthcare Reform and Infertility
On March 23, 2010 the new health care reform became law. The Patient Protection and Affordable Care Act (sometimes referred to as ObamaCare) will be phased in over the course of several years. While the law does much to provide access to care it does little for couples trying to conceive. In fact it does more to hurt than it does to help; it raises costs. The law has more to do with preventing and ending pregnancy, then helping couples start families.
Some benefits are provided for pregnant women in the form of a Medicaid requirement to cover counseling and pharmacotherapy for smoking cessation. The only other pregnancy related component relates to funding of abortion. In March of 2012 a controversial mandate was added to require coverage of contraceptives.
Costs for infertility treatments will be higher for couples beginning in 2014. Two funding components of the regulation will raise costs for couples paying for infertility procedures. Infertility procedure expenses not covered by insurance are tax deductible, however the law diminishes the tax savings. Flexible Spending Account contributions will be limited to $2,500 annually. Currently there is no cap, although most employers choose the contribution limit and many elect amounts far above this future amount. The floor for taking deductible medical expenses will be raised from 7.5% of Adjusted Gross Income (AGI), to 10.0% of AGI.
Common Exceptions to Infertility Mandates
Prior to passage of the PPACA health insurance plans were primarily regulated at the state level. Fifteen states have enacted some form of mandate specific to infertility coverage, but include exemptions for: religious organizations, self insuring employers, employer size, and more.
In almost every case religious organizations are exempt from complying with any mandate. If you work directly for a church, or subsidiary, or affiliated organization your plan may not have coverage. Many religious organizations object to the use of any artificial reproductive technique on moral grounds.
Most mandates apply to insurance companies issuing medical plans. Often larger employers choose to self insure in order to better control costs. These employers are not considered insurers and therefore are not subject to the regulations.
Most laws apply the requirements to group health plans based upon the number of employees. Larger employers are included in the requirements, but smaller ones often are not. Each state have differing sets of rules.
In Situs and State Mandates
Surf over to any forum addressing infertility and you are bound to read a post from somebody looking for insurance to cover infertility because their employer is headquartered outside of the mandate state where the poster lives. Friends working for other employers have coverage, but they don’t.
Mandates apply to insurance plans based upon where the policy is issued, not where insured lives or works. The important insurance term to know and understand is “In Situs” where the policy originates. Group health insurance plans are represent the majority of medical plans subject to mandates, and these plans are governed by the rules in one state: the In Situs state.
People post to forums when something is missing: their employer is not subject to the local mandate. Couples who live in non mandate states, but work for employers sitused in mandate states don’t post to forums - they already have what they need. So the awareness of how this rule works is very low.
But this is the key for finding coverage. Find employers sitused in mandate states that employ workers in your local area. Apply for a job with one of these employers.
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