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Insurance Coverage for Infertility in San Diego

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As couples and individuals undergoing fertility treatments already know, the road to family building can be very expensive. IVF cycles are costly, and women often require several cycles.

Currently, only 15 states have mandates that require insurance companies to offer coverage for infertility treatments. Fortunately for residents of San Diego, California is one of the states that require this mandate.

The mandate regarding infertility coverage can be found in the California Health and Safety Code, Section 1374.55. This code clarifies that insurers must offer coverage for infertility diagnosis and treatment. Any health insurance plan that covers hospital, medical, or surgical expenses must offer infertility insurance coverage, yet it is not obligated to provide the coverage, nor are employers forced to include it in their plans.

The code further defines infertility as a demonstrated condition recognized by a doctor as the cause for infertility, or the inability to conceive or carry a pregnancy to term after one year of unprotected sexual intercourse. It lists infertility treatment as diagnostic tests, medication, surgery, and Gamete Intrafallopian Transfer (GIFT).

However, California’s mandate explicitly excludes IVF procedures from the list of approved infertility treatments. Additionally, religious organizations with beliefs that contradict with certain infertility treatments are not required to offer the coverage.

Before you begin your infertility treatments, it is a good idea to talk with a representative from your insurance plan, so you can understand what diagnostics, treatments, or procedures will be covered.