15 States That Require Fertility Treatment To Be Covered By Insurance - Zupnick Associates

(by: Eseoghene Andre)

Infertility’s Issues

Infertility is an issue that affects every 1 in 8 couples – 1 in 8 couples that can attest to the multitude of problems with try to deal with the problem of infertility. Infertility can be due to a medical diagnosis or LGBTQ marriages where the couple desire to raise children. Whatever the case may be, the fact is that fertility treatments are not new to society. In fact, studies show that at least 10% of women seek treatment for infertility.

However, the truth is that the total costs of fertility treatments can be quite expensive, it can cost between $10,000 to $17,000 per cycle. Prior to now, standard health insurance plans did not cover fertility treatments, because they are not “medically necessary” (as reproduction is not essential to a person’s survival).  At best, fertility tests were covered by insurance, but for most it was considered a luxury. 

Actual fertility treatments like IVF or ART are still usually not included. Even LGBTQ couples are exempted from federal insurance when they want to undergo such treatments. To be able to access fertility treatments, one would have to pay from their own pockets or be lucky enough to have an employer that offers such health insurance packages.

Hope Reigns

However, as the world evolves out of a survival state, and into a more empathetic one, more state laws are requiring that fertility treatments be covered by insurance. 15 States in the US have required that insurance companies cover infertility treatments. Let us look at these 15 States and what these new state laws on health insurance could mean for you and your partner. 

These states include:

  • Connecticut
  • Arkansas
  • Delaware
  • Hawaii
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Montana
  • New Hampshire
  • New Jersey
  • New York
  • Ohio
  • Rhode Island
  • West Virginia

Couples in these states are more likely to receive financial assistance from their health insurance plan for fertility therapies. There are however some criteria that might exclude couples from accessing this insurance. Some of these criteria include:

  • Age
  • Duration of marriage
  • Duration of Infertility diagnosis
  • Heterosexual couples
  • Cause of infertility

Proceed With Caution

If you meet all the requirements demanded by your state, then you can go ahead to rely on your insurance. However, it is important to note that the law might vary depending on the state you live in. 

For example, in Louisiana and New York State, the law states that a medical condition that is otherwise covered, cannot be excluded from coverage solely because it causes infertility. Minnesota law states that fertility drugs used to boost fertility will not be covered by medical assistance; while health insurance coverage for IVF is specifically excluded in California, Louisiana, and New York, and some states cover insurance for 1 to 3 cycles of IVF. 

It is important to know what the law is in your state.

Employer-Sponsored Fertility Insurance 

Especially in recent years, employers have been tapping into the benefits of offering fertility treatment coverage as part of their group health options, as well. 

With 63% of employers expressing a desire to cover fertility therapies beyond infertility diagnosis, and 76% of women saying they would prefer to work for a firm that provides fertility benefits over one that does not, it’s clear that fertility insurance can assist organizations in attracting and retaining top staff. 

If you reside or work in a state with an infertility coverage policy, you should ask your employer the following questions to see if you are covered by the state law.

  • How Fully or NOT Fully Insured Are You?

 State insurance laws must be followed by fully insured programs. Employers are not required to obey state insurance laws if they have self-insured or self-funded insurance programs.

  • What Type of Plan Options Do You Have?

 Firms that are not considered ALEs in their states may not offer other options than the one they provided at the start. Ask your employer if you have room in your existing plan to adjust some of your perks to a more personal need – like infertility treatment.

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