Purchasing supplemental health insurance covering In Vitro Fertilization (IVF) and infertility treatment outcomes is realistic, valuable, and makes having a baby far more affordable.

Unfortunately, getting supplemental insurance to pay for the treatments themselves is fantasy – unless the underlying problem is a covered medical condition – which is very rare.

Women have one opportunity to begin coverage for these important plans – before conception – which is now. Once you conceive, it will be too late!

  • Replacing mom’s income during an extended maternity leave
  • Protecting finances when twins or triplets deliver preterm
  • Covering medically necessary treatments for conditions causing infertility

Supplemental Insurance Covering Infertility Outcomes

Supplemental health insurance covers the likely outcome of infertility and In Vitro Fertilization. The objective is for the woman to conceive and bring home a baby using an assisted reproductive procedure.

Purchasing two policies prior to conception helps to offset five common exposures that frequently occur during pregnancy and childbirth.

  1. Mom loses income during an extended high-risk pregnancy leave before her due date.
  2. The unpaid maternity leave continues while she recovers from normal childbirth.
  3. Her labor and delivery fees exceed the hospital deductible in the family plan.
  4. High-order-multiples often spend time in Neonatal Intensive Care generating more bills.
  5. Many parents lose their job and health care benefits after an extended absence.

Supplemental Disability Insurance

Supplemental short-term disability insurance covers infertility and IVF outcomes. This private policy replaces a portion of mom’s income during the time she is unable to work because of a covered pregnancy-related medical condition.

Request a quote here for a policy that you can purchase outside of your employer. Coverage must begin prior to conception. The company will exclude any pre-existing pregnancy for twelve months. Start now! This type of plan will not cover mom’s recovery from normal labor and delivery. You must buy this more comprehensive plan through your employer. Employers must offer the option.

Do not finance IVF or any other ART procedure without buying this policy first. Most couples need both incomes to make the monthly installment payments. How will you stay current on these bills if mom is unable to work for months? State-based programs in California and Texas illustrate two opposite ends of the spectrum.

California

Several state-based government programs in California illustrate the value of supplemental short-term disability insurance for IVF and infertility outcomes. Most couples qualify for these government entitlements without taking proactive steps prior to conception.

  1. The California Pregnancy Leave Act offers job and health care security for up to four months.
  2. California State Disability Insurance (SDI) program replaces 55% of mom’s income during a pregnancy leave, and while she recovers from childbirth.
  3. The California Paid Family Leave program replaces 55% of both mom and dad’s income while they take time from work to bond with their baby at home.
  4. California Family Rights Act extends job and insurance protections for baby bonding time.

Texas

Purchase supplemental short-term disability insurance in Texas for infertility and IVF outcomes. Couples working in the Lone Star State have a pronounced need. Texas does not offer any state-based programs that address the common risks for new parents.

  1. Texas does not have a state temporary disability coverage. Couples must purchase a private policy prior to conception in order to protect mom’s income.
  2. Texas does not have any state family leave laws to extend the time or expand eligibility to the federal FMLA. Many new parents face job and health care loss if mom conceives multiples or experiences a high-risk pregnancy.

Supplemental Hospital Insurance

Supplemental hospital indemnity insurance covers IVF and infertility outcomes. This private policy makes a claims payment when mom delivers her baby in a hospital. It makes an additional payment for each infant that requires specialized care.

Higher multiple birth rates are associated with therapies such as ovulation-inducing drugs and assisted reproductive technologies (ART). Infants born in twin, triplet deliveries are at higher risk of adverse birth outcomes compared to singletons. More than 1 of every 2 twins and more than 9 of every 10 triplets are born preterm or low birth weight.1

Supplemental hospital indemnity works like insurance against a twin or multiple pregnancy. Begin the coverage prior to conception – which is right now!

Supplemental Insurance Covering Infertility Treatments

Supplemental health insurance may pay for infertility treatments when the underlying cause is a covered medical condition. A covered medical condition must meet two key criteria.

  1. The cause is not a pre-existing condition. This means having a physical condition for which the person received medical advice, testing, treatment, or taken medication within 12 months before the effective date.
  2. The treatment is medically necessary. This means the health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

Most companies consider infertility treatments as elective – not medically necessary. In addition, most couples begin looking for a plan after they know they need it. In other words, they wait until they have a pre-existing condition.

State insurance mandates do not apply to supplemental plans. Therefore, the list of covered treatments is much shorter than the list of uncovered services.

Covered Treatments

Supplemental health insurance may cover treatments for the underlying medical condition that causes problems with fertility. Applicants must show evidence of good health. In addition, any new policy will contain a 12-month exclusion for pre-existing conditions. Therefore, applicants healthy enough to qualify must wait 12 months for the coverage to begin.

Below is a short list of medically necessary conditions making it difficult to conceive. The two supplemental insurance plans highlighted above could cover treatments for these conditions.

  1. Polycystic Ovarian Syndrome (PCOS) causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. The treatment for PCOS (lifestyle changes and medications) rarely trigger a claim for any supplemental policy.2
  2. Endometriosis symptoms include painful periods (dysmenorrhea), pelvic pain and cramping, excessive bleeding and infertility. Treatments for endometriosis include pain medications, hormonal therapy, and conservative laparoscopic surgery. The two supplemental policies might cover the surgery if the operation results in lost income, or requires a hospital stay.3
  3. Uterine fibroids that impinge upon the endometrial cavity (submucosal) affect fertility. Treatments for uterine fibroids include hormones to regulate the menstrual cycle, non-invasive and traditional surgical procedures. The two supplemental insurance plans are most likely to cover the traditional invasive surgical procedures. Invasive operations often take place in a hospital, require an overnight stay, and prevent the patient from working during an extended recovery.4

Uncovered Treatments

Supplemental health insurance does not cover any elective infertility treatment. The companies do not classify assisted reproductive technologies as medically necessary. Patients should not expect either of the two policies to pay claims in support of any of the following procedures or services.

  • Fertility drugs
  • Intrauterine insemination (IUI)
  • In vitro fertilization (IVF)
  • Intracytoplasmic sperm injection (ICSI)
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Donor eggs and embryos
  • Gestational surrogacy

Sources:

  1. Multiple Birth
  2. Polycystic Ovarian Syndrome
  3. Endometriosis
  4. Uterine Fibroids
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