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Massachusetts Insurance Coverage for Infertility

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One of the most pressing issues for couples struggling with infertility is how they will pay for their treatment. IVF procedures can cost thousands of dollars, and many times, more than one cycle is necessary.

Fortunately, residents of Massachusetts can rest a little easier, thanks to a state mandate, The Massachusetts Infertility Mandate, that requires insurance companies to acknowledge infertility as a covered disease.

Only 15 states currently have laws requiring insurance companies to cover fertility treatments and procedures, and Massachusetts was the first state to enact such a mandate. In 1987, Massachusetts passed the law under "Infertility, pregnancy-related benefits" in the Massachusetts General Laws, Chapter 175, Section 47H.

This law defines infertility as the condition of an otherwise healthy individual who is not able to conceive during a period of one year. It requires all insurers that provide pregnancy-related benefits to cover diagnostics and treatment for infertility, including artificial insemination, IVF, GIFT, egg or sperm procurement processing, sperm or egg banking, ICSI, and ZIFT.

In recent years, Massachusetts had another victory for fertility-related insurance issues. The 2005 Massachusetts Acts, Chapter 111, expanded the MassHealth program to cover infertility treatments or family planning services for individuals or families whose incomes are at least up to 200 percent of the federal poverty level.

Exceptions to Massachusetts Infertility Mandate

As exceptions to the law, insurance companies are not required to cover experimental infertility procedures, surrogacy, reversal or voluntary sterilization, or crypopreservation of eggs (egg freezing). Additionally, employers who self-insure are exempt from the requirements stated above.

This law can only be enforced if health insurance companies are based in Massachusetts. For example, if your company or employer is based in another state, your health plan may not be covered under Massachusetts jurisdiction

The Massachusetts Infertility Mandate requires that insurance companies provide coverage for certain fertility procedures, but it does not set the level of coverage. When looking at fertility treatment costs, it is important to calculate applicable co-pays as well as prescription drug plan reimbursement.