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Massachusetts Infertility Insurance Mandate

Massachusetts is one of 15 states that has a state mandate in place that requires insurance plans to offer coverage or provide coverage for IVF costs and fertility treatments. Massachusetts’ law on infertility insurance coverage is found in Chapters 175 and 176 of the Annotated Laws of Massachusetts, as well as 211 CMR 37.00 of the Division of Insurance Regulations.

Massachusetts law on infertility insurance coverage was first enacted in 1987. According to the Massachusetts infertility insurance law , health insurance companies and health maintenance organizations (HMOs) that cover pregnancy-related benefits must also provide coverage for the medically necessary expenses for infertility diagnosis and fertility treatment costs, including IVF costs. The Massachusetts fertility treatment insurance law was amended in 2010 to redefine the definition of infertility.

The law on fertility treatment insurance redefined the definition of infertility as an individual who is “unable to conceive or produce conception” during a period of one year if the woman is under the age of 35. If the woman is over the age of 35, the period of time is only six months.

Massachusetts law on coverage for fertility treatment costs clarifies the fertility treatments that will be covered. Covered fertility treatments include artificial insemination (AI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) , sperm, egg, or inseminated egg retrieval, intracytoplasmic sperm injection (ICSI) for male infertility, and zygote intrafallopian transfer (ZIFT). The Massachusetts infertility insurance mandate also specifies that insurance companies cannot impose limitations, restrictions, or exclusions on coverage for fertility treatment drugs that are different from those imposed on other prescription drugs.

Massachusetts Infertility Insurance Mandate Limitations

According to the Massachusetts infertility insurance mandate, insurance companies are not required to provide coverage for the following fertility treatments:

  • Any experimental fertility treatment or procedure, until the procedure has been recognized as non-experimental by the Commissioner
  • Surrogacy
  • Reversal of voluntary sterilization
  • Cryopreservation of eggs (egg freezing)
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