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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.