State Infertility Insurance Laws Mandating Coverage

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 infertility insurance coverage, but these laws vary widely in term of who and what is covered. Loopholes abound, so know exactly how the laws work.

Thirty Five states have no infertility mandate. But don't let that stop you. Many couples who live in non-mandate states do have coverage. Most insurance laws regulate group plans. Group health insurance plans are regulated based upon the situs state: where the plan was issued. Employers headquartered in mandate states must comply with these mandates for employees living in all states.

This is the key to finding infertility insurance coverage.

States With Infertility Mandates

Arkansas

The Arkansas 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

California mandate 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

Connecticut decrees that individual and group health insurance policies are cover medically necessary expenses for infertility diagnosis and treatment. Covered treatments include ovulation induction, intrauterine 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

Illinois regulation requires insurance policies that cover more than 25 people and provide pregnancy-related benefits to cover costs of the diagnosis and treatment of infertility.

Louisiana

Louisiana orders that insurance carriers cover the "diagnosis and treatment of correctable medical conditions." Insurers may not deny coverage for treatment of a correctable medical condition only because the condition results in infertility. Coverage is not required for fertility drugs; in vitro fertilization or any other assisted reproductive technique.

Maryland

Maryland mandates that 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 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

The Montana mandate 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 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 act 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 directive requires health maintenance organizations to cover basic preventive health services, including infertility. Experimental procedures are not covered.

Rhode Island

The Rhode Island Directive 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

Texas mandates that 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 directive requires health maintenance organizations to cover basic health care services, including infertility services, when medically necessary.

Interrelated

State Infertility Insurance Laws Mandating Coverage

States With Infertility Mandates