Single women or same-sex female couples often face insurance coverage issues when undergoing artificial insemination with donor sperm.
Fifteen states have passed laws that require insurers to cover or offer coverage for infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. But even when states that have legislation mandating coverage, that coverage doesn’t always include IVF and other reproductive therapies. It also isn’t necessarily extended to same-sex couples or single women.
Part of the challenge comes from the way infertility is defined. To meet the medical criteria of infertility, a woman must fail to conceive after 12 months of unprotected intercourse. For a woman aged 35 and older, the timespan is reduced to 6 months.
In some cases, however, an insurance policy may state that the relationship must be a heterosexual one between a man and a woman of reproductive age to meet coverage criteria. Even in states that mandate coverage of infertility treatment, the policy may specify the egg be fertilized with the partner’s sperm.
For same-sex female partners who have insurance coverage, infertility must still be proven. Often, that means women 35 years or younger must pay out-of-pocket for 12 cycles of physician-supervised IUI (intrauterine insemination) or IVF (in vitro fertilization) without conceiving, (Women over the age of 35 may be required to undergo six unsuccessful cycles.)
In some cases, IUI or other infertility treatments may be covered if an underlying cause of infertility – such as endometriosis – can be identified. Insurance coverage for physician visits, diagnostic testing and treatment may also be provided for women who have been diagnosed with premature ovarian failure before the age of 40, depending on the specific plan.
In recent years, employers have become more open to providing infertility coverage to single and same-sex couples.
An October 2017 survey of 497 companies conducted by Willis Towers Watson found that health care programs are evolving with many companies across all major industry sectors offering and enhancing fertility benefits, including coverage for same-sex couples.
Of the companies surveyed that currently offer fertility benefits, 65% included coverage for same-sex couples. Based on survey results, that percentage is expected to climb to 81% by 2019.
Contact your local URA clinic in Hasbrouck Heights, Hoboken, and Wayne, NJ for more information. Your friendly URA team will be happy to provide more details on insurance coverage for artificial insemination.