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Insurance Coverage for Fertility Treatment

There are only 15 states in the United States that require insurance coverage for fertility treatment. Some states mandate that providers cover fertility treatments, while others mandate that providers “offer” coverage (e.g. letting customers know coverage options available to them, but not requiring them to cover it).

States Who Have Laws on Fertility Treatment Insurance

Currently, the following states require insurance coverage for infertility treatment: Arkansas, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia.

Texas and California laws mandate that insurance plans “offer” coverage.

Exemptions and Inclusions in Infertility Insurance

Even if you reside in one of the states that requires insurance coverage for fertility treatment, you may not have a policy that has to adhere to the governing state law. If your employer buys an insurance plan through a health insurance company, state regulations apply. However, if it is a self-funded benefits program, your health coverage is regulated only by the federal ERISA law, which has no provision for infertility treatment. In some cases, employers with few employees do not have to provide coverage. Also, if your employer's policy was not written in the governed state, it may be exempt.

Other plans, such as those purchased by you individually or offered by school districts or religious organizations, may also be exempt from state regulation.

Plans that cover fertility treatment still require thorough research to determine the qualifications associated with that coverage. Not all of these plans will cover in vitro fertilization (IVF) or other assisted reproductive technology (ART) procedures and the fertility drugs associated with them. Some plans will only pay for infertility-related expenses after the patient proves a history of unexplained fertility, undergoes other cheaper methods of treatment or has a particular diagnosed issue. Further, some plans stipulate age requirements, number of IVF cycles allowed and a lifetime maximum reimbursement limits.

Ask Questions about Insurance Coverage for Infertility in Your Plan

Find out about your insurance plan by asking your provider how they define “infertility” and what coverage is listed. Learn about restrictions governing the type of fertility specialist you see and if pre-authorizations are necessary. Ask about limits that apply to the coverage in terms of fertility treatment cycles, procedures, prerequisites and drug coverage.

It is difficult to navigate through insurance plans as they vary greatly in what they cover and what they require for that coverage. Take the time to do the appropriate research, so you can take full advantage of what your plan has to offer, as well as be prepared financially if that coverage falls short.

Comments

I live in the state of Arkansas and have insurance with through my husband's employer. I have at least a 2 yr history of unexplained infertility and have tried 6 attempts with artificial insemination with no success. It is my understanding that under the Arkansas Insurance Coverage for IVF that my insurance should cover me up to $15,000 for IVF if I meet all the listed criteria in the law. My husband's employer is not self insured. He works for a electric utility company in Arkansas but their "home office" is located in Ohio. Am I understanding right that I should be covered up to $15,000 for IVF since I meet the criteria? I called my insurance company but they just said they would look into it and get back with me, I feel like that they might just be putting me off, maybe not. Any help would be greatly appreciated.

Thanks
Misty
scootsuz@yahoo.com

In this article you suggested moving to another stte that has coverage especially if it is a bordering state. I have also seen people change jobs because they knew that there was better coverage at a particular company. I worked for a company associated with a hospital that had an IVF clinic. They were self insured and covered a cycle for $2,000. Again, this isn't feasible for everyone but a possible option to consider!

I don't reside in those states but I can see that's a serious problem it could be for many reasons, so I wanna look for the best insurance, here I found great information about it but I need a ittle bit more information.

Infertility treatment indeed needs an insurance coverage.

Learn about restrictions governing the type of specialist you see and if pre-authorizations are necessary. Ask about limits that apply to the coverage in terms of treatment cycles, procedures, prerequisites and drug coverage

i came to your blog instantly and amazed to see that its full of info what i was searching for

It proved to be very helpful to me and I am sure to all the commenters here! It's always nice when you can not only be informed, but also entertained! I'm sure you had fun writing this article.I have boon looking everywhere to find the information bout this you know.

I think different companies have different criteria for provide coverage & claim in such type of insurance policies.....that true?

Thanks for the information!

I am actually surprised that insurance companies cover infertility treatment. It's very good to hear though.

i came to your blog instantly and amazed to see that its full of info what i was searching for

I just want to ask you if the Philippines is also in the coverage on this insurance. I hope that you will make an update soon.

The blog was absolutely fantastic! Lot of great information which can be helpful in some or the other way. Keep updating the blog,looking forward for more contents...Great job, keep it up..

This site says a lot. Very informative. I'm so impressed.

Although advances in infertility treatment have helped many of couples become parents, the procedures are not without dispute.

mutuelle santé

Information provided by this blog is really helpful for people who want to get insurance plans for fertility treatment. These plans can cover the cost of whole procedures of fertility treatment.
http://www.ivftreatments.org/

We Are In Washington State Looking For Health Ins. That Helps With IVF?? Have Insur. Now That Does NOT Cover The Procedure..!! Can Any One Help With Some Information? Have Been Calling All Over And All They Want Is To Get Our Information So They Can Call All Day To Get Us To Sign up For insur. That Wont Even Help With What We Need..!! Frustrated..!

NY plans are not required to cover any treatment but just diagnosis and testing for infertility.

I have a united healthcare thru my job but insurance said it does cover diagnosis and testing but does not cover treatment. So my wife has a uterus septum and needs to be removed does any one knows if the insurance will cover this or not ?

You should call your plan administrator, and they will be able to tell you what specific procedures are covered. Best, Claire

My wife has a uterus septum and the doctor that she has is not the kind we looking for very unprofessional and don't believe he can do the job properly so if any one knows a doctor in chicago area that its a good and has used this doctor for this kind of surgery please help us out and give me the name thanks

Our Patient Care Advocates can absolutely help you find a fertility doctor in Chicago that is an experienced surgeon. Please contact us at 855-955-2229 or carecoordinator@fertilityauthority.com. Best, Claire

I hope every woman who is pregnant obtain health insurance, so they do not have to worry

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