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Maryland Infertility Insurance Mandate

The state of Maryland is one of only 15 states that has an infertility insurance mandate in place, which requires health insurance plans to offer coverage or provide coverage for fertility treatment costs. Maryland infertility insurance law can be found in the Maryland Insurance Article Section 15-810.

According to this law, health and hospital insurance policies that provide pregnancy-related benefits must also include benefits from expenses resulting from in vitro fertilization (IVF) procedures. Health maintenance organizations (HMOs) are required to provide in vitro fertilization benefits to the same extent as the benefits provided for other fertility treatments or infertility services. This 2000 Maryland fertility treatment insurance law is an amendment of the original 1985 law.

The Maryland infertility insurance mandate exempts employers from 50 or fewer employees from having to cover IVF costs. Religious organizations whose beliefs or practices conflict with fertility treatments may be exempt from this requirement, at the request of the religious organization.

Maryland Infertility Insurance Mandate Limitations

Like many of infertility insurance plans in operation by other states, Maryland’s infertility insurance law does contain a number of limitations. In order for IVF costs to be covered by insurance, the following conditions must be met:

  • The patient’s eggs must be fertilized by her husband’s sperm
  • The couple must have a two-year history of infertility, unless the infertility is associated with the following conditions: endometriosis, exposure in utero to diethylstilbestrol (DES), blockage or surgical removal or one or both fallopian tubes, or abnormal male factor infertility, including oligospermia (low sperm count)
  • The IVF procedure must be performed at a fertility clinic or medical facility that conforms to standards and guidelines set by the American Society for Reproductive Medicine (ASRM) or the American College of Obstetricians and Gynecologists

The Maryland infertility insurance mandate also sets three as the maximum number of IVF cycles that can be covered. IVF costs from these three cycles cannot exceed the maximum lifetime benefit of $100,000.

Comments (26)

I think I may have found the answer to my question, which is not what I was hoping for. The MD Insurance Administration page on health insurance mandates specifies the following: "The law exempts certain carriers and health benefit plans from the mandatory benefits and offerings requirements. These include: ... The federal government’s health benefit plans. States do not regulate federal government health programs." Basically the coverage requirement articulated in the mandate does not extend to Federal employees.

Hello, My husband and I live in Washington, DC. I am an employee of the federal government and our insurance is through my job. Right now we have BCBS Federal coverage. We are considering moving across the state line to MD so that we can benefit from the mandate for coverage of fertility treatment. Do you know whether the federal government complies with/is required to comply with the MD Mandate in the provision of healthcare to it's employees that are MD residents? If not, can you please advise me as to where I can get some answers? We are planning to move in the fall so that we can be ready to switch our insurance over when open season comes around. Thanks!

I had my tubes tied back in 2008 and now I want to have a baby do you know if the state of Maryland insurance cover vitro fertilization

Hello Anita,

Undergoing a tubal ligation procedure is considered an elective decision. Insurance would not cover any fertility treatment in response to elective sterilization unfortunately.

Best of luck

Hello Anita,

Undergoing a tubal ligation procedure is considered an elective decision. Insurance would not cover any fertility treatment in response to elective sterilization unfortunately.

Best of luck

Hi Kim, I have a MD written insurance plan with UHC which covers up to 30,000 including fertility medication. I just completed my 1st cycle of IVF. I found out that UHC paid about double the price of self-pay price. So of the maximum benefit of 30,000, I've already spent 21,000 in medication for just one cycle. I spoke with the pharmacy and they informed me that the price of medication is mandated by UHC not the pharmacy. I thought with the 30K, I could do 2-3 cycles but I am already maxed out. Is there anything I could do? Thanks, Katie

Go to doctor Kiltz in New York. His ivf cycle cost is approximately 1/5 of what it is in the DC area... Just saying

Hello, If our three ivf attempts are unsuccessful, can we switch insurance and have more attempts covered? We're in MD and have MD insurance. Thanks

Yes I actually spoke to an insurance agent who advised me that you can actually do that! Also if you are successful and decide you no longer want coverage you can cancel the plan at anytime as long as its not through your employer.

Here is what my Aetna insurance said: The plan was written in the state of California. This law requires an offer of coverage only. It does not mandate that employers or insurers provide coverage for infertility treatment. However, your plan provides coverage for basic infertility treatment. Basic infertility treatment covers services for the diagnosis and treatment of the underlying cause of the infertility. You or your doctor may contact the Infertility Department at 1-800-575-5999. Currently, the plan does not cover expenses incurred for artificial insemination, in-vitro fertilization or GIFT, because they do not correct the underlying cause of infertility. So my question is-I saw CA is also a IVF mandated state, since my policy is written in CA, wouldn't they have to offer IVF coverage?

My wife and I are going throught the testing and diagnostic procedures now at Shady Grove. My insurance company states that only the procedure itself is covered, non of the diagnostic procedures. Does that sound right? Thanks

Hi Bill,

That sounds confusing! I've heard of diagnostic testing being covered and NOT the treatment, but never the other way around. I say call them back and get clarification.

Best of luck!
Kim

Hi, My husband and I are both in real estate and therefore independent contractors. We currently pay for private insurance through Kaiser Permanente. They do not cover IVF. We are looking right now at paying 20K plus out of pocket for IVF at Shady Grove. Is there another option for us to pick up a secondary insurance that would cover IVF? And if so, do you know which companies cover IVF and how I would go about purchasing? Thank you!

Hi there,

Yes, unfortunately Kaiser does not cover much in the way of fertility treatment. I don't believe private insurances cover fertility, but you can contact Aetna, Blue Cross Blue Shield, or United Healthcare as they are the insurances that most often provide some degree of coverage.

Best,
Kim

Hi I live in PA and insurance in PA does not cover Infertility treatment (IVF, IUI). If I move to MD and get individual insurance, will that cover IVF, IUI. I plan to commute to PA for work. Thanks Dave

Hi Dave,

It is my understanding that individual insurance policies do not cover fertility treatment. Before purchasing a policy, make sure you are clear on what is covered and what is not.

Best,
Kim

My husband and I live in Maryland. My company is headquartered out of Maryland as well. When i ask questions they say the policies only cover fertility diagnostic nothing on this Maryland mandate. We have Blue Cross Blue Shield, do I need to find out where the policy is written even though my company is head quartered out of Maryland. I need a direction to go in to get more information.

Hi there,

Yes, you should find out where the policy is written to be absolutely sure.

Good luck!
Kim

Can you be covered in a mandated state through your insurance if you are a single parent wanting to get pregnant through artificial insemination?

Hi Ashley,

You should consult your insurance company to find out for sure, but I believe insurance companies will only cover medically necessary fertility treatments. Sadly, I don't think they cover treatment for same-sex couples or single women without a partner.

Best of luck to you!
Kim

Hello, I was reading above and just to understand. We live in MD but my husbands insurance is based out of MN, does that mean the MD mandate law is void for us?

Hi Jennifer,

Unfortunately, yes. Despite the fact that you live in MD, your insurance is written in MN. There isn't a mandate in place in MN. You should call your insurance company to double check on the coverage for fertility testing and treatment though.

Good luck!
Kim

Hi Lisa,

Your insurance plan should have an infertility hotline. You can contact them and ask specifically what is covered. Your insurance policy should follow the mandate of whichever state it was written in, regardless of which state you live in. For example, if you live in New Jersey but your insurance policy was written in New York, you would have benefits under the NY mandate. Additionally, if your employer has less than 50 employees or is affiliated with a religious institution, they may be exempt from providing infertility coverage.

Best of luck!
Kim

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