Monday, November 4, 2013

Undergoing Infertility Treatments in Connecticut? Know Your State Insurance Laws

If you are undergoing infertility treatments, and work in Connecticut you may be one of the lucky few with reliable insurance coverage. Connecticut is one of only a handful of states with a law mandating that insurance plans cover infertility treatments. And the CT law covers a higher percentage of its citizens due to some specific language in the mandate. But with any law there are loopholes, and you should know the rules before getting started to avoid any nasty surprises down the road.

The Connecticut infertility health insurance law mandates that "certain individual and group health policies to cover medically necessary costs of diagnosing and treating infertility". It specifically includes in-vitro fertilization (IVF) up to 2 cycles with a maximum of 2 embryos per cycle.

Broadest Applications

The Connecticut law is broadest in its application because it applies to individual and group policies. Many state laws apply only to group policies, and often to groups of fifty or more employees. This is not the case in Connecticut. Virtually any healthcare plan is subject to this mandate. There are no limitations based on group size.

Loopholes Remain

As with any law you have to look closely at the wording to find exceptions to the rule. In this case you will find several loopholes. First, the law only applies where Connecticut has jurisdiction. If you work for an employer headquartered in another state with a branch location in CT, your insurance plan is not subject to the mandate.

Second, the law relates to health insurance policies "delivered, issued, amended, renewed or continued on or after October 1, 2005". Does your insurance plan fit this description?

There are other exceptions based upon age, limitations on the number of cycles for specific treatments, and there is no specific language limiting deductibles, co pays, co insurance etc.

Read your policy, call your insurer, and understand the Connecticut law before starting your infertility treatments.

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