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Illinois Infertility Insurance Mandate

Like only 14 other states, Illinois has an infertility insurance mandate in place that requires insurance companies to provide coverage for fertility treatments and IVF costs. Illinois fertility treatment insurance law is found in Chapter 215, Sections 5/356m and 125/5-3.

According to Illinois infertility insurance law, all health insurance policies that provide coverage for more than 25 employees and provide pregnancy-related benefits must also provide coverage for the diagnosis of infertility and fertility treatments. The Illinois law requiring fertility treatment insurance coverage became effective in 1991.

Fertility treatments covered under Illinois infertility insurance law include in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian transfer (GIFT) , zygote intrafallopian tube transfer (ZIFT), and low tubal ovum transfer.

The Illinois fertility treatment insurance law defines infertility as the “inability to conceive after one year of unprotected sexual intercourse or the inability to sustain a successful pregnancy.”

Illinois Infertility Insurance Mandate Limitations

The Illinois infertility insurance law contains the stipulations in regards to coverage for GIFT, ZIFT, and IVF costs. According to the infertility insurance mandate, these fertility treatments may only be covered if the following conditions are met:

  • The patient must have been unable to conceive or sustain a pregnancy through less costly, medically appropriate fertility treatments that are covered under the health plan
  • The patient has not completed four egg retrievals, except if a live birth follows a completed egg retrieval, then two more completed egg retrievals will be covered
  • The fertility treatment procedures must be performed at fertility clinics or medical facilities that follow the American College of Obstetric and Gynecology or the American Society for Reproductive Medicine’s guidelines for IVF procedures.

Additionally, religious organizations are not required to contain fertility treatments under their coverage plan if those fertility treatments violate their religious and moral teachings and beliefs.

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