West Virginia Law Mandating Infertility Coverage

West Virginia infertility and IVF insurance is available to some residents. The West Virginia infertility health insurance law mandates that Health Maintenance Organizations (HMO) provide coverage for diagnosis and treatment of infertility.

If your health plan is a PPO, POS, or traditional fee for service plan you may have to pay out-of-pocket for all infertility treatments.  The West Virginia mandate does not cover IVF costs 

Before beginning any infertility protocol learn:

• Who is covered
• What is covered
• Where the holes are
• What this means for you
  

The West Virginia infertility law addresses HMO's only. If your insurance plan is considered an HMO, West Virginia's law requires your plan to cover basic preventive health services, including infertility.

The West Virginia infertility insurance rules have many exceptions once you take a closer look. The law can only be enforced when West Virginia has jurisdiction to regulate.  If your employer is headquartered in another state, your health plan may not be subject to the Ohio mandate, but may be covered by that state mandate.

The law regulates HMO's, not employers. If you work for a large employer that self insures, you may not be covered. 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.

West Virginia IVF insurance coverage is hard to determine.  The law does not specifically require HMO's to provide IVF or any other specific infertility treatment.

The West Virginia law requires infertility services when medically necessary.  Most HMO's have determined that IVF is not medically necessary.

The West Virginia infertility insurance law stipulates that preventative infertility services are to be covered if the couple experiences an inability to conceive purely as a result of infertility problems (unexplained infertility, for example). Experimental procedures - determined on a case-by-case basis by the Insurance Department --are not covered. In Vitro Fertilization (IVF) is not considered a preventative service, and hence not subject to this mandate.

Every insurance plan leaves you with some level of un-reimbursed expenses. Things like co-pays, co-insurance, and out of network charges can add up very quickly. For example:

•Fertility drugs - Some prescription drug plans provide 50% reimbursement. The other 50% of your fertility drug costs are yours.
•Co-insurance - The amount of allowed charges that are your responsibility may run to 20% to 30%.
•Out of network fees - May come into play if your fertility clinic of choice is not in network with your plan. You will be responsible for the amounts over and above what the insurance company reimburses as usual customary and reasonable.

Cut your infertility treatment costs by 1/3 or more by using your flexible spending account to pay for un-reimbursed infertility treatment expenses.  You may get an interest free loan.

West Virginia inferitlity insurance is not available to all.  You may find that your employer does offer health insurance with infertility coverage.

And even if they do, you may find that you still have many left over bills. Be sure to take full advantage of our cost saving opportunities, and fund your maternity leave by purchasing supplemental health insurance before getting pregnant.