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Arkansas Infertility Insurance Mandate

Arkansas is one of only around 15 states in the United States that has an infertility insurance mandate in place that requires insurance plans to offer coverage or to provide coverage for fertility treatment and IVF costs. The Arkansas law on fertility treatment insurance coverage can be found in Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118.

According to this fertility treatment insurance law, which was enacted in 1987, all accident and health insurance companies in the state that cover maternity benefits must include in vitro fertilization (IVF) as a covered expense. Health maintenance organizations (HMOs) are exempt from the law.

Further information, including coverage details, applicability, and benefit levels, is clarified in the Arkansas Insurance Department Final Rule on In Vitro Fertilization, which became effective in 1991.

Arkansas Fertility Treatment Insurance Mandate Conditions

According to the Final Rule on IVF insurance coverage in Arkansas, the following conditions must be met in order to cover IVF costs:

  • The patient must be the insurance policyholder, or the spouse and covered dependent of the policy holder.
  • The patient’s eggs must be fertilized by her husband’s sperm
  • The couple must have a history of unexplained infertility for at least two years, unless the following conditions are present: endometriosis , in utero exposure to Diethylstilbestrol (DES), blockage or removal of one or both fallopian tubes, not as a result of voluntary sterilization, or abnormal factors contributing to male infertility
  • The IVF procedures must be performed at medical facilities licensed or certified by the Department of Health, fertility clinics that conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics, or facilities that meet the American Fertility Society minimal standards for IVF programs
  • The patient must have been unsuccessful in achieving pregnancy through any less costly fertility treatment options covered under the plan

Additionally, cryopreservation, the process by which embryos are frozen for future implantation, is included as an in vitro fertilization procedure.

The Arkansas infertility insurance mandate permits insurers to cap the lifetime benefits for IVF costs at $15,000. Insurers may include coverage for other fertility treatments and procedures, which would be considered an IVF benefit and subject to the same benefit levels. So other benefits paid for fertility treatments may be included under the maximum amount payable under the IVF benefit.

The IVF benefits are subject to the same deductibles, co-insurance, and out-of-pocket limitations that apply to the plan’s maternity benefits.

Comments (7)

can you please tell me the specific name of company that I can purchase independently to cover IVF. Thank you Paula Taylor

Then why does my insurance company claim it will not and can not pay for IVF? Who do I contact to fix this?!!? HELP I have been trying for 4 years!

Hi Jenn, It depends on the state in which your policy was written, if your company has the minimum number of employees required, and if your company has a religious affiliation. If your policy was written in a state that does not mandate coverage, then unfortunately you do not have mandated coverage. If your state says companies with 200 or more employees meet the mandate, but your company only has 25 employees, then they are exempt. If your company has a religious affiliation, they are exempt. It is best for you to talk to human resources to best understand what the insurance policy covers. We can also help you find a fertility doctor who offers financing. Give us a call at 1-855-955-BABY (2229) Good luck! Kim

In Arkansas, they will cover up to diagnosis. They went as far as laproscopy but that was it. My insurance is through my employer who covers way over 200 employees. The insurance co and my employer are neither affiliated with a religion. I could not even challenge a claim through the insurance company because the fertility clinic refused to even consider performing ivf until they had confirmation through my insurance co. My clock is almost tick ticked out. It is so frustrating to go to sites like this and RESOLVE to see it being claimed Arkansas will but they really don't. I

My husband and I meet all of the criteria. We are planning to start fertility treatment soon. So I contacted my insurance provider to get proof of this mandate coverage so that I could bring it with me to the Dr ( as some of them require this before commencing treatment). i contacted them about 3 months ago and they have not got back in touch with me. Is there anything I can do about this? On their website they state they will follow any and all state mandates. Should that be good enough for the fertility clinic?

Me and my wife are trying for a baby for more than two years(since 2008) in India, but she could not concieve because of my sperm motality factor(30% motile). My sperm count is about 26million/cc. So she has gone through IUI for 2 times. The doctor told us that we have 100% assuarance of having a baby if she goes through IVF. Suddenly we had to come to US for my company's requirement. We are now planning for IVF here. We are covered by CIGNA. Can we get infertility insurance(for IVF) ?

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