Source: http://www.ncsl.org/issues-research/health/insurance-coverage-for-infertility-laws.aspx
Timestamp: 2013-05-24 01:37:40
Document Index: 769482895

Matched Legal Cases: ['§ 23', '§ 23', '§ 23', '§ 1374', '§ 10119', '§ 38', '§ 38', '§ 431', '§ 432', '§ 5', '§ 15', '§ 19', '§ 47', '§ 8', '§ 4', '§ 4', '§ 256', '§ 33', '§ 33', '§ 17', '§ 17', '§ 17', '§ 17', '§ 3216', '§ 3221', '§ 4303', '§ 2807', '§ 1751', '§ 27', '§ 27', '§ 27', '§ 27', '§ 33']

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State Laws Related to Insurance Coverage for Infertility Treatment Updated March 2012
Ark. Stat. Ann. § 23-85-137 and § 23-86-118 (1987, 2011) require health insurance companies to cover services and procedures performed at a facility licensed by the Department of Health that conform to the guidelines and minimum standards of the American College of Obstetricians and Gynecologists for in vitro fertilization clinics and the American Society for Reproductive Medicine for programs of in vitro fertilization. (2011 SB 213)
Ark. Stat. Ann. § 23-79-509(a)(5) specifies that the Arkansas Comprehensive Health Insurance Pool shall not include coverage for any expense or charge for in vitro fertilization, artificial insemination or any other artificial means used to cause pregnancy.
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 group contractholders. 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.
Conn. Gen. Stat. § 38a-509 and § 38a-536 (1989, 2005) require 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.
Hawaii Rev. Stat. § 431:10A-116.5 and § 432.1-604 (1989, 2003) require 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.
Ill. Rev. Stat. ch. 215, § 5/356m (1991, 1996) 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 sperm artificial intrafallopian 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. (1996 Ill. Laws, P.A. 89-669)
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; H.B. 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, 2010) require 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. This law was amended in 2010 to change the definition of "infertility" to be a condition of an individual who is unable to conceive or produce conception during a period of one year if the female is under the age of 35, or during a period of six months if the female is over the age of 35. If a person conceives but cannot carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the one year or six month period. (SB 2585)
Minn. Stat. Ann. § 256B.0625 specifies that medical assistance shall not provide coverage for fertility drugs when specifically used to enhance fertility.
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. (SB 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.
N.J. Stat. Ann. § 17:48-6x, § 17:48A-7w, § 17:48E-35.22 and § 17B:27-46.1x (2001) require 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 intrafallopian transfer, zygote intrafallopian 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 fewer than 50 employees. (SB 1076)
N.Y. Insurance Law § 3216 (13), § 3221 (6) and § 4303(1990, 2002, 2011) prohibit 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 laws were amended in 2002 to require certain insurers to cover infertility treatment for women between the ages of 21 and 44 years. The laws exclude coverage for in vitro fertilization, gamete intrafallopian tube transfers and zygote intrafallopian tube transfers. The laws were amended again in 2011 by N.Y. laws, Chap. 598 to require every policy that provides coverage for prescription fertility drugs and requires or permits perscription drugs to be purchased through a network participating mail order or other non-retail pharmacy to provide the same coverage for perscription fertility drugs that are purchased from a network participating non-mail order retail pharmacy provided that the network participating non-mail order retail pharmacy agrees in advance to the same reimbursement amount and the same terms and conditions that the insurer has established for a newtork participating mail order or other non-retail pharmacy. The policy is prohibited from imposing additional fees, co-payments, co-insurance, deductibles or other conditions on any insured person who elects to purchase prescription fertility drugs through a non-mail order retail pharmacy. (2011 AB 8900)
N.Y. Public Health Law § 2807-v (2002) creates a grant program to improve access to infertility services, treatments and procedures from the tobacco control and insurance initiatives pool.
Ohio Rev. Code Ann. § 1751.01 (A) (7) (1991) requires health maintenance organizations (HMOs) to provide basic health care services, which include infertility services, when medically necessary.
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. (2007 R.I. Pub. Laws, Chap. 411, SB 453)
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 health maintenance organizations (HMOs) only.
Sources: The National Conference of State Legislatures and the American Society for Reproductive Medicine: State Infertility Insurance Laws. Note: List may not be comprehensive, but is representative of state laws that exist. NCSL appreciates additions and corrections. Resources
Centers for Disease Control and Prevention: Assisted Reproductive Technology
Infertility: A Public Health Focus on Infertility Prevention, Detection, and Management
2008 Assisted Reproductive Technology Report