Connecticut Infertility Insurance Mandate

Connecticut is one of only 15 states that currently has an infertility insurance mandate in place requiring insurance companies to offer coverage for fertility treatments or to provide coverage for fertility treatment and IVF costs. Connecticut law on fertility treatment insurance is found in Public Act No. 05-196, which was enacted in 1989.

This law, which became effective in 2005, requires individual and group insurance plans to provide coverage for “the necessary expenses of the diagnosis and treatment of infertility.” According to this law, infertility is defined as the condition of an otherwise healthy individual who has been unable to conceive or sustain a successful pregnancy during a one-year period.

Fertility treatments covered under Connecticut infertility insurance law include ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), uterine embryo lavage, embryo transfer, gamete intrafallopian transfer (GIFT) , zygote intrafallopian transfer (ZIFT), and low tubal ovum transfer.

Before seeking coverage for fertility treatment and IVF costs, individuals covered under their insurance plans must disclose prior fertility treatments they received under different health care policies.

Connecticut Infertility Insurance Mandate Limitations

Like many of the state infertility insurance mandates, there are certain limitations included under the Connecticut infertility insurance mandate. The following limitations to coverage exist under the infertility insurance law:

• Individuals seeking fertility treatment coverage must be under the age of 40
• Coverage for ovulation induction is limited to a lifetime maximum of four cycles
• Coverage for IUI is limited to a lifetime maximum of three cycle
• Lifetime coverage for IVF, GIFT, ZIFT, and low tubal ovum transfer is limited to two cycles with no more than two embryo implantations per cycle
• Individuals seeking coverage must have maintained their coverage under the policy for at least 12 months

Additionally, covered fertility treatments must be performed at fertility clinics or facilities that conform to the guidelines developed by the American Society for Reproductive Medicine (ASRM) or the Society of Reproductive Endocrinology and Infertility.

This law exempts religious employers, who are allowed to exclude fertility treatments from their health plan if they go against that religion’s bona fide religious beliefs.