For couples who have been trying to conceive naturally for at least 1 year (in some states) and have failed, there may be help depending upon where you live. The important note here is the state in which you live. Most states do not mandate coverage for infertility. Insurance companies do not like to cover infertility treatments because they are very expensive, particularly with IVF. Since the insurance companies work hand and hand with the state legislators, the results are obvious.
Each state has there own requirements as to who, what, when and when not, and how much infertility insurance is to be covered in the policy. Here is the way it works.
Definition of Infertility
Infertility in couples has a different definition in each state. Some require at least one year, while other states require up to five years of trying before being considered for coverage. Other states have an age limit, while others do not; Connecticut's age limit is 40 years, New Jersey's is 46.
The states that do define infertility also impose eligibility based upon how long you've been living in the state as well as how long you've been trying to conceive. Maryland requires a history of infertility for 2 years while Hawaii needs a 5 year history and Illinois only 1 year. There is also some conditions on the type of infertility that is eligible such as endometriosis, blocked or surgically removed fallopian tubes or abnormal male factors. California does not mandate that insurance companies cover IVF, while other states place no such restrictions. Insurance companies also have their own strict requirements and limitations.
Coverage of Infertility Insurance
What is covered and what is not covered also is defined by those states that mandate coverage. The procedures for infertility treatment must be covered at a licensed facility in Arkansas and they are limited to a total lifetime amount of $15,000 and that includes cryopreservation. Maryland has a $100,000 limit, a much more realistic figure for IVF's to take hold. Rhode Island has the same limit, but the insurance company offering the infertility insurance may impose up to a 20% co-payment in that state.
Ohio requires HMOs to cover infertility services when they are medically necessary, but IVF are not required by law. Texas also has a mandate, but no coverage is required, except for IVF - figure that one out. You can get in-vitro fertilization, but that's it, even though their are so many other procedures that are far less costly.
Exceptions to Infertility Insurance
Almost all states that mandate procedures make an exception for employers who are self-insured or in some states religious employers or employers with less than 50 employees do not have to provide coverage. Other exceptions also include experimental, sex change, voluntary sterilization or surrogacy.
Just because you live in a state that does not mandate infertility insurance does not mean that an insurance company operating in your state does not carry that type of insurance. The best way to treat infertility is to avoid the costly procedures and not deal with overwhelming bureaucracy developed by the insurance companies.For couples who have been trying to conceive naturally for at least 1 year (in some states) and have failed, there may be help depending upon where you live. The important note here is the state in which you live. Most states do not mandate coverage for infertility. Insurance companies do not like to cover infertility treatments because they are very expensive, particularly with IVF. Since the insurance companies work hand and hand with the state legislators, the results are obvious.
Each state has there own requirements as to who, what, when and when not, and how much infertility insurance is to be covered in the policy. Here is the way it works.
Definition of Infertility
Infertility in couples has a different definition in each state. Some require at least one year, while other states require up to five years of trying before being considered for coverage. Other states have an age limit, while others do not; Connecticut's age limit is 40 years, New Jersey's is 46.
The states that do define infertility also impose eligibility based upon how long you've been living in the state as well as how long you've been trying to conceive. Maryland requires a history of infertility for 2 years while Hawaii needs a 5 year history and Illinois only 1 year. There is also some conditions on the type of infertility that is eligible such as endometriosis, blocked or surgically removed fallopian tubes or abnormal male factors. California does not mandate that insurance companies cover IVF, while other states place no such restrictions. Insurance companies also have their own strict requirements and limitations.
Coverage of Infertility Insurance
What is covered and what is not covered also is defined by those states that mandate coverage. The procedures for infertility treatment must be covered at a licensed facility in Arkansas and they are limited to a total lifetime amount of $15,000 and that includes cryopreservation. Maryland has a $100,000 limit, a much more realistic figure for IVF's to take hold. Rhode Island has the same limit, but the insurance company offering the infertility insurance may impose up to a 20% co-payment in that state.
Ohio requires HMOs to cover infertility services when they are medically necessary, but IVF are not required by law. Texas also has a mandate, but no coverage is required, except for IVF - figure that one out. You can get in-vitro fertilization, but that's it, even though their are so many other procedures that are far less costly.
Exceptions to Infertility Insurance
Almost all states that mandate procedures make an exception for employers who are self-insured or in some states religious employers or employers with less than 50 employees do not have to provide coverage. Other exceptions also include experimental, sex change, voluntary sterilization or surrogacy.
Just because you live in a state that does not mandate infertility insurance does not mean that an insurance company operating in your state does not carry that type of insurance. The best way to treat infertility is to avoid the costly procedures and not deal with overwhelming bureaucracy developed by the insurance companies.
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