Infertility Insurance Mandate States

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Infertility Insurance Mandate States

Out of the 50 states in the United States, there are only 15 that have any sort of mandate for infertility insurance coverage. The mandate in each states is different, so do your research about your state's laws and whether the mandates apply to your employer.

Arkansas: All health insurers that cover maternity benefits must cover the cost of in vitro fertilization (IVF); however,  health maintenance organizations (HMOs) are exempt from the law, and insurers may limit coverage to a lifetime maximum of $15,000. The Arkansas law on fertility treatment insurance coverage can be found in Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118.

California: Group health insurers covering hospital, medical or surgical expenses must let employers know infertility coverage is available. The law does not require insurers to provide the coverage; and it doesn't force employers to include it in their employee insurance plans. It also specifically exempts insurers from having to offer coverage for IVF. The law can be found in California Health and Safety Code, Section 1374.55.

Connecticut: Both individual and group health polices are required to cover medically necessary expenses for the diagnosis and treatment of infertility. The individual must have maintained coverage under the policy for at least a year and must disclose any prior fertility treatments they had under a different insurance carrier. Coverage is limited to two cycles of IVF, with not more than two embryo transfers per cycle. The law can be found at Public Act No.05-196.

Hawaii: Individual and group health insurance plans, hospital contracts or medical service plan contracts that provide pregnancy-related benefits must pay a one-time benefit for IVF outpatient costs. Patients have to have at least a five-year history of infertility to have their IVF covered. The law can be found in Hawaii Revised Statutes, Sections 431-lOA-116.5 and 432.1-604. 

Illinois: Insurance policies covering more than 25 people and providing pregnancy-related benefits must cover the costs of the diagnosis and treatment of infertility. It covers up to four egg retrievals for IVF after patients have used all reasonable, less expensive and medically appropriate treatments. The law can be found in the Illinois Compiled Statutes Annotated, Chapter 215, Sections 5/356m and 125/5-3.

Louisiana: Health insurance policies, contracts or plans cannot exclude coverage for the diagnosis and treatment of a correctable medical condition otherwise covered under the plan, solely because the condition results in infertility. The law can be found in the Subsection 215.23, Acts 2001, No. 1045, subsection.

Maryland: Health and hospital insurance policies issued or delivered in Maryland that provide pregnancy-related benefits to also cover the outpatient costs of IVF. Patients and their spouses must have had at least a two-year history of infertility, and coverage may be limited to three IVF attempts per live birth and a maximum lifetime benefit of $100,000. The law can be found in the Maryland Insurance Article §15-810, Health General Article §19-706

Massachusetts: HMOs and insurance companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment. Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs. The law can be found in Annotated Laws of Massachusetts, Chapters 175 and 176' 211 CMR 37.00 of the Division of Insurance Regulations.

Montana: HMOs must cover infertility services as part of basic preventive health care services, but for health insurers other than HMOs, the law specifically excludes infertility coverage from the required scope of health benefits those insurers must provide. The law can be found in the Montana Code Annotated, Sections 33-22-1521 and 33-31-102.

New Jersey: Insurance policies that cover more than 50 people and provide pregnancy-related benefits must cover the cost of the diagnosis and treatment of infertility. The patient will receive coverage for up to four egg retrievals after using all reasonable, less expensive and medically appropriate treatments without being able to get pregnant or carry a pregnancy. The law can be found in New Jersey Permanent Statutes: 17B:27-46.1X Group Health Insurance Policies; 17:48A-7W Medical Service Corporations; 17:48-6X Hospital Service Corporations; 17:48E-35.22 Health Service Corporations; 26:2J-4.23 Health Maintenance Organizations.

New York: Private, group health insurance plans are required to cover the diagnosis and treatment of correctable medical conditions and can not exclude coverage of a condition solely because the medical condition results in infertility. They are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. IVF is excluded from this requirement; however, the fertility medications IVF may be covered if the plan provides prescription drug coverage.  The law can be found inNew York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).

Ohio: HMOs must provide basic health care services, which include infertility services, when medically necessary. The law can be found in Ohio Revised Code Annotated §1751.

Rhode Island: Insurers and HMOs that cover pregnancy services must cover the cost of medically necessary expenses of diagnosis and treatment of infertility, which is defined as a healthy married individual who is unable to conceive after one year. The law can be found in Rhode Island General Laws (§ 27-18-30, 27-19-23, 27-20-20 and 27-41-33).

Texas: Certain insurers that cover pregnancy services must offer coverage for IVF, which means they must let employers know this coverage is available, but the insurers do not have to provide the coverage; and employers do not have to include it in their health plans. The law can be found in Texas Insurance Code, Article 3.51-6.

West Virginia: HMOs must cover basic health care services, including infertility services, when medically necessary. However, infertility services is not defined. The law can be found in West Virginia Code §33-25A-2.