State infertility insurance laws require coverage in fifteen jurisdictions. Most plans will not cover artificial reproductive treatment unless compelled by a government authority.
The requirements vary by whom is covered, and what procedures are included. Loopholes and exceptions abound, and regulations work differently than many expect.
The laws might affect you no matter where you live. Do not overlook how these requirements apply to employers!
- Interpreting infertility mandates
- Indirect coverage for IVF multiple birth exposures
Infertility Insurance Mandate States
There are fifteen infertility insurance mandates states. Do not make one very common mistake. The legal requirements do not work the way you might expect.
The mandates apply primarily to group plans, and follow the rules of the “In Situs” jurisdiction. Exemptions and exclusions may also apply. Knowing these rules is the key to finding insurance to cover infertility.
In Situs Definition
State infertility insurance mandates apply to plans based on where the policy is issued, not where the member lives or works. The important term to know and understand is “In Situs” – where the policy originates.
Group healthcare plans represent the majority subject to mandates, and these plans are governed by the rules in the “In Situs” jurisdiction.
Surf over to any online forum for couples trying to conceive. You are bound to read a post from somebody complaining about a common loophole. Her employer is headquartered outside of where the poster lives. Friends working for other employers have coverage, but they do not.
People post to forums when something is missing: their employer is not subject to the local regulation. Couples who live in non-mandate areas (such as Pennsylvania or Florida), but work for employers based in mandate jurisdictions do not post to forums – they already have what they need.
Therefore, the awareness of how this rule works is very low. However, this is the key to finding the Holy Grail.
Find local employers based in jurisdictions with an infertility mandate. Apply for a job with one of these employers.
|New Jersey||New York||Ohio|
|Rhode Island||West Virginia|
Exemptions and Exclusions
State mandated infertility insurance coverage frequently contains other exclusions and limits based upon:
- Specific treatment is often excluded
- In Vitro Fertilization
- Tubal ligation reversal
- Vasectomy reversal
- Plan designs such as HMO
- Employer size
- Religious organizations
- Government employers
IVF Insurance Mandate States
While certain regulations specifically exclude In Vitro Fertilization, others specifically include it. The list of IVF mandate states has only eight entries.
Either the remaining forty-two have no regulation or they explicitly exclude the treatment. The list may grow to include fifty entries when you consider how where the group healthcare plan is issued.
Several indirect state IVF insurance laws reveal themselves when the treatments succeed. Lost income and lost employment are often two common risks couples face.
State mandated short-term disability provides income replacement for mom while she is unable to work. Unfortunately, this program exists in only five jurisdictions, and the benefit level is often rather low.
Federal maternity leave laws provide job protections. However, the rights last only twelve weeks, and forty percent of workers do not qualify. Local regulations may extend the length of time, and/or qualify more workers.
State IVF insurance laws and multiple birth rates is often a united theme. Proponents of expanded regulation often point a possible correlation between the presence of a law, and the number of embryos transferred per cycle.
The theory is that couples are less likely to transfer multiple embryos when a third party picks up the tab.
The average cost of IVF in the United States approaches $15,000 per cycle. Many couples pay this amount completely out-of-pocket. Transferring multiple embryos increases the chances of conception, and thereby reduces the number of cycles needed to conceive.
Multiple embryo transfers also increase the odds of twins or triplets. Twins and triples often deliver preterm and rack up large bills after an extended stay in neonatal intensive care.
Health insurance exchanges allow couples to choose plans with an in-network level four neonatal intensive care unit. They may also qualify for premium and cost-sharing subsidies.