State Laws Related to Insurance Coverage for Infertility Treatment
approximately 10 percent of the us. uu. women of childbearing age have received assistance for infertility. Infertility is generally defined as failure to conceive after at least one year of regular, unprotected intercourse. Common methods of infertility treatment include various insemination techniques and hormone therapy to stimulate egg production. assisted reproductive technology (art) are procedures in which pregnancy is attempted through the use of external means; For example, eggs are fertilized outside the uterus and then placed in a woman’s uterus through in vitro fertilization (IVF). More than 72,913 babies were born in the United States in 2015 as a result of non-donor art procedures. The Centers for Disease Control and Prevention estimate that art represents just under two percent of the US total. births.
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Although advances in infertility treatment have helped thousands of couples become parents, the procedures are not without controversy. Such procedures can be quite expensive: According to the University of Iowa Steady Children’s Family Hospital, each IVF cycle costs an average of $12,000 to $17,000, and there is debate about whether insurance plans should cover them. studies have shown that pregnancies resulting from arts are associated with an increased risk of pregnancy complications compared to pregnancies conceived spontaneously.
Reading: What states require insurance to cover ivf
since the 1980s, 17 states (arkansas, california, connecticut, delaware, hawaii, illinois, louisiana, maryland, massachusetts, montana, new hampshire, new jersey, new york, ohio, rhode island, texas, and west virginia ) have passed laws requiring insurers to cover or offer coverage for the diagnosis and treatment of infertility. Of those states, 15 have laws requiring insurance companies to cover infertility treatment, and two states, California and Texas, have laws requiring insurance companies to offer > coverage for infertility treatment.
some of these laws are unique; For example, Utah requires insurers that provide coverage for maternity benefits to also provide an indemnity benefit for adoption or infertility treatment. louisiana and new york prohibit exclusion of coverage for an otherwise covered medical condition solely because the condition results in infertility. Minnesota specifies that Medical Assistance will not provide coverage for fertility drugs when used specifically to enhance fertility. While most states with laws that require insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California, Louisiana, and New York have laws that specifically exclude coverage for the procedure.
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summary of statutes
ark. ana statistic § 23-79-510 specifies that the arkansas comprehensive health insurance group will not include coverage for any expenses or charges for in vitro fertilization, artificial insemination, or any other artificial means used to cause a pregnancy.
ark. ana statistic § 23-85-137and § 23-86-118 (1987, 2011) require accident and medical insurance companies to cover in-flight fertilization. vitro. Services and procedures must be performed in a facility licensed or certified by the Department of Health and meet the guidelines and minimum standards of the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine. (2011 sb 213)
cal. health & security code § 1374.55 and cal. Insurance Code § 10119.6 require specific group health care service plan contracts and health insurance policies to provide coverage for infertility treatment, except in vitro fertilization. The law requires each plan to communicate the availability of coverage to group contract holders. the law defines infertility, infertility treatment and in vitro fertilization. The law clarifies that religious employers are not required to offer coverage for forms of treatment that are incompatible with the organization’s religious and ethical principles. the law was amended by 2013 cal. statistics., ch. 644 (ab 460) to specify that infertility treatment shall be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, marital status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.
with. gene Statistics § 38a-509 and § 38a-536 (1989, 2005) require that the Health insurance organizations provide coverage for medically necessary expenses in the diagnosis and treatment of infertility, including in vitro fertilization procedures. infertility, in this case, refers to a healthy individual who is unable to conceive or produce conception or maintain a successful pregnancy for a period of one year. amended in 2005 to provide an exemption for coverage that is contrary to the religious beliefs of an employer or individual.
hawaii rev. Statistics § 431:10a-116.5 and § 432.1-604 (1989, 2003) require all health insurance policies and of accidents that provide pregnancy-related benefits to also include a one-time benefit for outpatient expenses arising from in vitro fertilization procedures. To qualify for in vitro fertilization procedures, the couple must have a history of infertility for at least five years or demonstrate that the infertility is the result of a specific medical condition.
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bad. Rev. statistics chap. 215, § 5/356m (1991, 1996) requires certain insurance policies that provide pregnancy-related benefits to provide coverage for the diagnosis and treatment of infertility. coverage includes in vitro fertilization, uterine embryo flushing, embryo transfer, artificial insemination, gamete and sperm intrafallopian tube artificial transfer, zygote intrafallopian transfer, and lower fallopian tube ovum transfer. coverage is limited to four complete oocyte retrievals, except if a live birth follows a complete oocyte retrieval, then two complete oocyte retrievals are covered. (1996 ill. laws, p.a. 89-669)
the. Rev. ana statistic § 22:1036 prohibits the exclusion of coverage for the diagnosis and treatment of a medical condition otherwise covered by the policy, contract or plan, solely because the condition results in infertility. Insurers are not required by law to cover fertility drugs, in vitro fertilization or other assisted reproductive techniques, tubal reversal, vasectomy, or any other method of sterilization. (2001 la. acts, p.a. 1045)
dm. insurance code ann. § 15-810 (2000) amends the original 1985 law and prohibits certain health insurers that provide pregnancy-related benefits from excluding benefits for all outpatient expenses arising from the pregnancy. in vitro fertilization procedures performed. The law clarifies the conditions under which services must be provided, including a history of infertility for at least a 2-year period and infertility associated with one of several listed medical conditions. An insurer may limit coverage to three IVF attempts per live birth, not to exceed a maximum lifetime benefit of $100,000. The law clarifies that an insurer or employer may exclude coverage if it conflicts with the religious beliefs and practices of a religious organization, at the request of the religious organization. Regulations that went into effect in 1994 exempt businesses with 50 or fewer employees from having to provide IVF coverage. (2000 md. laws, cap. 283; h.b. 350)
dm. general health code ann. § 19-701 (2000) includes family planning or infertility services in the definition of health care services.
mass. gene laws ann. chap. 175, § 47h, chap. 176a, § 8k, chap. 176b, § 4j, chap. 176g, § 4 and 211 massachusetts code of regulations 37.00 (1987, 2010) require general insurance policies, hospital without for-profit service corporations, medical service corporations, and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization. this law was amended in 2010 to change the definition of “infertility” to be a condition of a person being unable to conceive or produce conception for a period of one year if the woman is under 35, or for a period of six months if the woman is over 35 years old. if a person conceives but is unable to carry that pregnancy to a live birth, the period of time she attempted to conceive before achieving that pregnancy shall be included in the calculation of the one-year or six-month period. (SB 2585)
min. ana statistic § 256b.0625 specifies that Medical Assistance will not provide coverage for fertility drugs when used specifically to enhance fertility.
month. ann code § 33-22-1521 (1987) revises certain requirements of the Montana Comprehensive Health Association, the state’s high-risk pool, and clarifies that covered expenses do not include charges for artificial insemination or infertility treatment. (sb 310)
month. ann code § 33-31-102 et seq. (1987) requires health maintenance organizations to provide basic health services on a prepaid basis, including infertility services. other insurers are exempt from having to provide the coverage.
n.j. ana statistic § 17:48-6x, § 17:48a-7w, § 17:48e-35.22 and § 17b:27-46.1x (2001) require health insurers to provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, including medications, surgery, infertility in vitro, embryo transfer, artificial insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection, and four complete egg retrievals per covered person’s lifetime. The law includes some restrictions, as well as a religious exemption for employers who provide health coverage to fewer than 50 employees. (SB 1076)
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n.y. insurance law § 3216 (13), § 3221 (6) and § 4303(1990, 2002, 2011) prohibit individual and group health insurance policies from excluding coverage for hospital, surgical, and medical care for the diagnosis and treatment of correctable medical conditions that would otherwise be covered by the policy solely because the medical condition results in infertility. The laws were amended in 2002 to require certain insurers to cover infertility treatment for women between the ages of 21 and 44. the laws exclude coverage for in vitro fertilization, gamete intrafallopian transfers, and zygote intrafallopian transfers. the laws were amended again in 2011 by n.y. laws, chap. 598 to require all policies that provide coverage for fertility prescription drugs and require or allow prescription drugs to be purchased through a participating network mail order or other non-retail pharmacy to provide the same Coverage for prescription fertility drugs purchased at a participating network retail mail-order pharmacy as long as the participating network retail mail-order pharmacy accepts the same reimbursement amount and terms and conditions in advance that the insurer has established for a participating network mail order or other non-retail pharmacy service. The policy is prohibited from imposing additional fees, copayments, coinsurance, deductibles, or other conditions on any insured person who elects to purchase prescription fertility drugs through a non-mail order retail pharmacy. (2011 ab 8900)
n.y. public health law § 2807-v (2002) creates a grant program to improve access to infertility services, treatments, and procedures from the insurance and control initiatives group tobacco.
ohio rev. ann code § 1751.01 (a)(1)(h) (1991) requires health maintenance organizations (hmos) to provide basic health care services, which are defined to include infertility services, when medically necessary.
r.i. gene laws § 27-18-30, § 27-19-23, § 27-20-20 and § 27-41-33 (1989, 2007)require any health insurance contract, plan or policy (individual and group), nonprofit hospital service, nonprofit medical service, and health maintenance organization to provide coverage for medically necessary expenses for the diagnosis and treatment of infertility. the law clarifies that copays for infertility services do not exceed 20 percent. infertility is defined as the condition of a healthy married individual who is unable to conceive or produce conception for a period of one year. rhode island includes ivf coverage. amended in 2007 to increase the age of coverage for infertility from forty (40) to forty-two (42) and redefines infertility to refer to a woman who is unable to maintain a pregnancy for a period of one year. (2007 ri pub. laws, cap. 411, sb 453)
text. insurance code ann. § 1366.001 et seq. (1987, 2003) requires all health insurers to offer and make available coverage of services and benefits for expenses incurred or prepaid for outpatient expenses that may result from in vitro fertilization procedures. To qualify for in vitro fertilization services, the couple must have a history of infertility for at least five years or have specific medical conditions that result in infertility. the law includes exemptions for religious employers.
w. Virginia. Code § 33-25a-2 (1995) amends the 1997 law and requires health insurers to cover basic health care services, including infertility services. applies to health maintenance organizations (hmos) only.
sources: the national conference of state legislatures and the american society for reproductive medicine: state infertility insurance laws. Note: The list may not be exhaustive, but it is representative of the state laws that exist. ncsl welcomes additions and corrections.
- Centers for Disease Control and Prevention
- Frequently Asked Questions about Infertility
- Use of Infertility Services in the United States: Data from the National Survey of Family Growth, 1982-2010, National Report on Health Statistics, January 2014
- assisted reproductive technology
- Assisted Reproductive Technology Report 2015
- infertility and public health
- american society for reproductive medicine (asrm)
- infertility information resources
- society for assisted reproductive technology (sart)
- resolve: the national infertility association
path2parenthood (formerly the American Fertility Association)
note: ncsl provides links to other websites for informational purposes only. Providing these links does not indicate ncsl’s endorsement or approval of the site.