Insurance Coverage for Infertility Care

It is no secret that infertility treatment can be costly (an average of $12,400 per IVF cycle), yet only 15 states mandate insurance coverage for infertility care. According to a 2014 National Health Statistics Report, about 12 percent of U.S. women of childbearing age (or their husbands or partners) have used infertility services.

 

FERTILITY FRIENDLY STATES

There are wide discrepancies in infertility coverage and treatment accessibility from state-to-state. While some states, including New Jersey, are considered “fertility friendly,” others either do not mandate infertility care or have limited mandates that cover testing and diagnosis, but not the actual treatment.

State mandates are laws that require health plans sold by licensed insurers to include coverage for specific benefits, in this case, infertility care. Fifteen states – Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia, have mandates requiring insurers to offer coverage or cover infertility treatment and diagnosis

The top states for fertility benefits, according to Resolve, a nonprofit focused on reproductive health, include Connecticut, Illinois, Maryland, Massachusetts and New Jersey.

 

NEW JERSEY STATE MANDATE

Since 2001, the state of New Jersey has required all health insurers that cover groups of 50 or more to provide hospital or medical benefits for medically necessary expenses incurred in the diagnosis and treatment of infertility. These services must be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

The mandate requires the same copayments, deductibles, and limits are applied to infertility benefits as to other medical or surgical benefits. A separate copayment, coinsurance, deductible, dollar maximum, visit maximum or procedure maximum may not be imposed on any infertility treatment with the exception of limiting infertility coverage to four completed egg retrievals per lifetime for the covered person.

Religious employers may exclude specific coverage when it is contrary to their tenets or doctrine. Written notification of these exclusions must be provided to all prospective insured or covered persons.

 

UNDERSTANDING CO-INSURANCES AND DEDUCTIBLES

Even when diagnosis and treatment of infertility are covered by insurance mandates, certain personal costs often apply. This may include the following:

 

 

INSURANCE SAVVY

It is important to become familiar with the infertility mandates in your state and to develop an understanding of your personal health insurance policy concerning infertility care. This knowledge will help you prepare for upcoming expenses and may also determine the affordability of infertility diagnostic testing and treatment.

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