Infertility Insurance Coverage Not the Norm in the United States
Pursuing infertility treatment can be devastating. To add insult to injury, only a minority of U.S. states have laws requiring some type of infertility insurance benefits. The list of states includes Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.
Know that each state, employer, and insurance company differs with regards to infertility insurance coverage. To be safe, do your homework and ask questions. Make sure you know exactly what you will owe upfront.
Coverage differs by state
Currently 15 states are legally mandated to offer some type of infertility insurance coverage. There are differences between each of these states and exclusions do apply. Some exclusions include:
- Whether an insurers is required to cover in vitro fertilization (IVF)
- Differing definitions of what infertility is
- Whether or not specific employers cover infertility diagnosis or treatment services
Your state could be next in mandating infertility insurance coverage. To make a difference and advocate for coverage in your state, visit RESOLVE’s Center for Infertility Justice.
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 or 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.
If you are already a patient at a fertility clinic, ask the finance staff if they can check your benefits for you. They may offer some helpful hints to help you afford treatment.
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?
- RESOLVE: The National Infertility Association: Health Insurance 101
- RESOLVE: The National Infertility Association: Insurance Coverage in Your State
- RESOLVE: The National Infertility Association: The Center for Infertility Justice