US Infertility Therapy Coverage Resources in United States
US Infertility Therapy Coverage Resources
Updated April 2008
Approximately 12 percent of U.S. women of childbearing age, about 1 in 8 couples, have received assistance for infertility. Usually, infertility is defined as the absence of conception after at least one year of regular, unprotected intercourse. More than 27,000 babies were born in the United States in 2005 as a result of non-donor assisted reproductive technology (ART) procedures. Common methods of infertility treatment include various insemination techniques and hormone therapy to stimulate egg production. Assisted reproductive techniques are procedures in which pregnancy is attempted through the use of external means; for example, eggs are fertilized outside the womb and then placed into a woman’s uterus through in vitro fertilization (IVF).
Although advances in infertility treatment have helped thousands of couples become parents, the procedures are not without controversy. Such procedures can be quite expensive–on average each cycle of IVF costs, $8,158 plus an average of $4,000 for medications–and debate exists about whether insurance plans should be required to cover them. Cost estimates for insurance coverage of infertility treatments range from an additional $0.20 to $2.00 per member per month. Recently, studies have shown that assisted reproductive technologies have contributed to an increase in multiple births, which have a higher rate of prematurity than single births. In 2004, 8.1 percent of all newborns were low birthweight (less than 5.5 pounds), the highest percentage since the early 1970s. Preterm births cost society at least $26 billion per year.
Since the 1980s, 14 states, Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia, have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Twelve states have laws that require insurance companies to cover infertility treatment. Two states, California and Texas, have laws that require insurance companies to offer coverage for infertility treatment. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California and New York have laws that specifically exclude coverage for the procedure.
| State |
Summary of Statutes |
||
| Alabama | |||
| Alaska | |||
| American Samoa | |||
| Arizona | |||
| Arkansas | Ark. Stat. Ann. § 23-85-137 and §23-86-118 (1987) require health insurance companies to cover the expenses of in vitro fertilization procedures only. | ||
| California |
Cal. Health & Safety Code § 1374.55 requires health care service plan contracts that cover hospital, medical, or surgical expenses on a group basis to offer coverage for the treatment of infertility, except in vitro fertilization. The law requires every plan to communicate the availability of coverage to policyholders. The law defines infertility, treatment for infertility and in vitro fertilization. The law clarifies that religious employers are not required to offer coverage for forms of treatment that are inconsistent with the organization’s religious and ethical principles. Cal. Insurance Code § 10119.6 (1989) requires insurers to offer coverage of infertility treatments, except in vitro fertilization. Infertility, in this case, may be a result of a medical condition or may refer to the inability to carry a pregnancy to term during a one-year or more period of time. Infertility treatment refers to diagnosis, diagnostic tests, medication, surgery, and gamete intrafallopian transfer. |
||
| Colorado | |||
| Connecticut | Conn. Gen. Stat. § 38a-536, and § 38a-509 (1989, 2005) requires that health insurance organizations provide coverage for medically necessary expenses in the diagnosis and treatment of infertility, including in vitro fertilization procedures. Infertility, in this case, refers to an otherwise healthy individual who is unable to conceive or produce conception or to sustain a successful pregnancy during a one-year period. Amended in 2005 to provide an exemption for coverage that is contrary to the religious beliefs of an employer or individual. | ||
| Delaware | |||
| District of Columbia | |||
| Florida | |||
| Georgia | |||
| Guam | |||
| Hawaii | Hawaii Rev. Stat. § 431:10A-116.5 and § 432.1-604 (2003, 1989) requires all accident and health insurance policies that provide pregnancy-related benefits to also include a one-time only benefit for outpatient expenses arising from in vitro fertilization procedures. In order to qualify for in vitro fertilization procedures, the couple must have a history of infertility for at least five years or prove that the infertility is a result of a specified medical condition. [c 332, §2 and c 276, §4] | ||
| Idaho | |||
| Illinois | Ill. Rev. Stat. ch. 215, § ILCS 5/356m (1991, 1997) requires certain insurance policies that provide pregnancy-related benefits to provide coverage for the diagnosis and treatment of infertility. Coverage includes in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete spermartificialintrafallopian tube transfer, zygote intrafallopian tube transfer, and low tubal ovum transfer. Coverage is limited to four completed oocyte retrievals, except if a live birth follows a completed oocyte retrieval, then two more completed oocyte retrievals are covered. [P.A. 89-669] | ||
| Indiana | |||
| Iowa | |||
| Kansas | |||
| Kentucky | |||
| Louisiana | |||
| Maine | |||
| Maryland | Md. Insurance Code Ann. § 15-810 (2000) amends the original 1985 law and prohibits certain health insurers that provide pregnancy-related benefits from excluding benefits for all outpatient expenses arising from in vitro fertilization procedures performed. The law clarifies the conditions under which services must be provided, including a history of infertility of at least a 2 year period and infertility associated with one of several listed medical conditions. An insurer may limit coverage to three in vitro fertilization attempts per live birth, not to exceed a maximum lifetime benefit of $100,000. The law clarifies that an insurer or employer may exclude the coverage if it conflicts with the religious beliefs and practices of a religious organization, on request of the religious organization. Regulations that became effective in 1994 exempt businesses with 50 or fewer employees from having to provide the IVF coverage. [2000 Md. Laws, Chap. 283; HB 350]Md. Health General Code Ann. § 19-701 (2000) includes family planning or infertility services in the definition of health care services. | ||
| Massachusetts | Mass. Gen. Laws Ann. ch. 175 § 47H,ch. 176A § 8K, ch. 176B § 4J, ch. 176G § 4, and 211 Code of Massachusetts Regulations 37.00 (1987) requires general insurance policies, non-profit hospital service corporations, medical service corporations and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization. The law defines “infertility” as the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year.2005 Mass. Acts, Chap.111-2005 expands MassHealth program to cover infertility related costs for those eligible. [H.B. 4178] | ||
| Michigan | |||
| Minnesota | |||
| Mississippi | |||
| Missouri | |||
| Montana | Mont. Code Ann. § 33-22-1521 (1987) revises certain requirements of Montana’s Comprehensive Health Association, the state’s high-risk pool, and clarifies that covered expenses do not include charges for artificial insemination or treatment for infertility. [S.B. 310]Mont. Code Ann. § 33-31-102(2)(v), et seq. (1987) requires health maintenance organizations to provide basic health services on a prepaid basis, which include infertility services. Other insurers are exempt from having to provide the coverage. | ||
| Nebraska | |||
| Nevada | |||
| New Hampshire | |||
| New Jersey | N.J. Stat. Ann. § 17:48-6x; 17:48A-7w; 17:48E-35.22; 17B:27-46.1x (2001) requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility, including medications, surgery, in vitro fertilization, embryo transfer, artificial insemination, gamete intra fallopian transfer, zygote intra fallopian transfer, intracytoplasmic sperm injection and four completed egg retrievals per lifetime of the covered person. The law includes some restrictions as well as a religious exemption for employers that provide health coverage to less than 50 employees. [SB 1076] | ||
| New Mexico | |||
| New York | N.Y. Insurance Law § 3216 (13), 3221 (6) and 4303 (1990, 2002) prohibits individual and group health insurance policies from excluding coverage for hospital care, surgical care and medical care for diagnosis and treatment of correctable medical conditions otherwise covered by the policy solely because the medical condition results in infertility. The law does not require coverage for in vitro fertilization. Amended in 2002 to also require certain insurers to cover infertility treatment for women, age 21-44 years. The law excludes coverage for in vitro fertilization, gamete intrafallopian tube transfers and zygote intrafallopian tube transfers.N.Y. Public Health Law § 2804-v (2002) creates a grant program to improve access to infertility services, treatments and procedures from the tobacco control and insurance initiatives pool. | ||
| North Carolina | |||
| North Dakota | |||
| Ohio | Ohio Rev. Code Ann. § 1751.01 (A) (7) (1991) requires HMOs to provide basic health care services, which include infertility services, when medically necessary. | ||
| Oklahoma | |||
| Oregon | |||
| Pennsylvania | |||
| Puerto Rico | |||
| Rhode Island | R.I. Gen. Laws § 27-18-30, § 27-19-23, § 27-20-20 and § 27-41-33 (1989, 2007) require any contract, plan or policy of health insurance (individual and group), nonprofit hospital service, nonprofit medical service and health maintenance organization to provide coverage for medically necessary expenses for the diagnosis and treatment of infertility. The law clarifies that the co-payments for infertility services not exceed 20 percent. Infertility is defined as the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year. Rhode Island includes IVF coverage. Amended in 2007 to increase the age of coverage for infertility from forty (40) to forty-two (42) and redefines infertility to mean a woman who is unable to sustain pregnancy during a period of one year. | ||
| South Carolina | |||
| South Dakota | |||
| Tennessee | |||
| Texas | Tex. Insurance Code Ann. § 1366.001 et seq. (1987, 2003) requires that all health insurers offer and make available coverage for services and benefits for expenses incurred or prepaid for outpatient expenses that may arise from in vitro fertilization procedures. In order to qualify for in vitro fertilization services, the couple must have a history of infertility for at least five years or have specified medical conditions resulting in infertility. The law includes exemptions for religious employers. | ||
|
U.S. Virgin Islands |
|||
|
Utah |
|||
|
Vermont |
|||
|
Virginia |
|||
|
Washington |
|||
|
West Virginia |
W. Va. Code § 33-25A-2 (1995) amends the 1997 law and requires health insurers to cover basic health care services, which include infertility services. Applies to HMOs only. |
||
|
Wisconsin |
|||
| Wyoming |
Leave a Reply