Pursuing infertility treatment can be devastating. To add insult to injury, only a minority of U.S. states have laws addressing infertility insurance benefits. The list includes Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Before you pursue infertility treatment, verify your benefits. Differences exist among each state, employer, and insurance company, ultimately affecting what you will owe.
Coverage differs by state
Check out RESOLVE's list of insurance coverage by state. This webpage offers a detailed look at each state's laws on infertility insurance benefits. Some state-by-state differences include:
- Whether insurers must cover in vitro fertilization (IVF) or not
- Disagreements on what the diagnosis of infertility includes
- Some states have a "mandate to cover" policy, requiring your employer's insurance premium to cover the cost of infertility treatment
- Other states have a "mandate to offer" policy, meaning each employer can decide whether to offer infertility insurance benefits or not
Your state could be next in mandating infertility insurance coverage. Visit RESOLVE’s Center for Infertility Justice. This site is updated regularly with the latest infertility legal news.
Coverage differs by employer
Is your employer self-insured, a small business, or a religious organization? If so, your company may not have to abide by state laws regarding infertility insurance coverage. If your employer does not seem to be following state mandated laws, talk to your human resources representative to find out why. You can also contact your state's Insurance Commissioner's office for more information.
Coverage differs by insurer
Don't assume that your infertility treatment costs are covered, just because you live in one of the states listed above. Insurance companies still vary on coverage offered. To be safe, make sure that you understand the fine print of your health insurance policy. For instance, some insurers cover infertility testing and diagnostic procedures, but they may not cover infertility treatments like IVF. If your state does not have laws addressing infertility insurance, don't give up. You may still be eligible for insurance benefits for some infertility testing and treatment services. Contact your employer or insurance company to find out more.
Uncover your personal infertility insurance benefits
No one wants to be greeted with unexpected expenses at the fertility center. Check out the following resources to determine exactly what your plan covers:
- Visit your health insurance website online; your policy may be posted in full.
- Contact your human resources representative at your job.
- Contact your health insurance company directly.
- If you are already going to a fertility center, ask the staff if they can check your benefits for you.
Once you get your questions answered, ask the other party to put your infertility insurance benefits in writing. Or, if your benefits are posted on the web, print them out for your records. These records can give you peace of mind as you pursue infertility treatment.
Sources: American Fertility Association: Diagnosis and Treatment of Infertility: Am I Covered? http://www.theafa.org/library/article/diagnosis_and_treatment_of_infertility_am_i_covered/; Healthcare.gov; Resolve: The National Infertility Association: Health Insurance 101 http://www.resolve.org/family-building-options/insurance_coverage/health-insurance-101.html; RESOLVE: The National Infertility Association: Insurance Coverage in Your State http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html; RESOLVE: The National Infertility Association: The Center for Infertility Justice http://www.resolve.org/resources/the-center-for-infertility-justice.html
