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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 (41)

I live here in Maryland and have insurance here.. My fiance and I have been having a hard time conceiving within the past 3 years. Is there any information you could tell me whether or not my insurance would cover it and if it would be okay being that we are just engaged and not married yet?

We aren't able to speak directly to state mandates or insurance coverages. There are, though, a couple of places that may be able to help you find answers. The first question you need to ask yourself is, are you and your fiancé on separate insurance plans or is one of you a claimed dependent on the other's plan? Are you insured through work or the state insurance marketplace? If your insurance is through work, you will want to speak with your HR Benefits person as he or she will likely know if your plan covers fertility treatment. If you are on separate plans, you'll each want to speak with your HR Benefit person. You should also ask about claiming the other as a dependent in the event one of you has coverage but the other does not. If you are insured through the marketplace, you will need to follow up with a case worker-type person about your coverage. You might also call the 800 number on the back of your insurance card and speak with a member representative about your coverage. He or she should be able to look at your specific plan, tell what is/is not covered, and walk you through how to use it (pre-authorization? only certain tests covered? who is in network? those sorts of things). Lastly, if you are in contact with (or already a patient at) a fertility clinic, a patient financial counselor may be able to help you determine your coverage as well. Keep in mind, even if fertility treatment is not covered, you MAY be able to get parts of your treatment covered. Sometimes ultrasounds, certain blood tests, and semen analyses can be covered, but you will want to work closely with your insurance so you aren't surprised with a bill. Best, Kelley

I had a hysterectomy 6 years ago !when I was just 18 and I just got married a year ago, we both live here in Maryland and we would like to have a baby of our own. Neither of us have insurance yet. We would like to start a process for in vitro. What would be the best insurance plan for us?

I'm sorry, we cannot advise on insurance plans or options. The Benefits Manager with your employer or the MD insurance marketplace may be able to help you select a plan.

I live and work in VA, but it looks like our CareFirst policy was written in MD. This means it must continue to offer IVF coverage, correct? It does currently offer limited coverage for heterosexual married couples, but the language excludes same-sex, unmarried, and singles. On CareFirst's compliance site I saw an updated policy number 4.02.001 updated, after MD state mandate S.B. 416 H.B. 838 passed 7/01/15, to require coverage for same-sex married couples. I don't understand the language, though, to understand if an employer ultimately has the right to override such language. "State Mandate" sounds like something an employer has to abide by, but I don't know. Could you offer any clarification?

We are unable to advise on state specific coverage legislature/requirement. I'm sorry I can't be of more help. It's possible your HR Health Benefits Manager may know, or may be able to help direct you to someone who can clarify for you.

Hello, I currently live and work on the state of Maryland, and have BCBS as my insurance carrier, was informed that it does not cover fertility treatments. Could please tell me which ate the exemptions to the mandate

We cannot speak to specific requirements for insurance. If you're working a fertility clinic already, it's possible their financial counselor (or person who requests insurance pre-approval) may have more information. Your HR Benefits Manager may also know more details.

Currently my Husbands company only has 48 people and our insurance was selected in Oct. Come the 1st of 2018 the company will increase to almost 100 people. Does the insurance mandate take effect as soon as the company exceeds 50 people or not until the following year when open enrollment occurs and the new insurance is effective?

My husband and I both work for St of Md. and each have single policy through Blue Cross. I used my insurance for our 3 IVF's and have miscarried all of them. Can I go on his insurance and have it covered?

I live in Maryland I'm having a hard time finding out where my insurance is located. I'm in local IBEW26. Which our union hall is in Maryland. And my company I work for under the union is in va. Is there any way I can find out from anyone where my insurance is out of and if it's out of Maryland how do I go about claiming mandated insurance? Thanks.

So we were planning on moving to MD from D.C. In order to get fertility coverage. Is the place where the insurance is based in all that matters regarding benefitting from the mandate or do we need to move to the state as well? My work insurance BCBS is out of TN but I have AETNA which doesn't cover IVF so I was going to buy a plan out of MD. Which plans are based there that include IVF? If we just switch to that do we even need to move? Please help!

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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