IVF Babble

Fertility and Health Insurance in the US

Health insurance, either as a private policy or as part of your remuneration package at work, can vary greatly between both insurers and employers

So it’s important to take the time to read and understand your policy documents to see what you’re covered for, and what you’re not covered for. Knowing this is almost an insurance in itself, for you to know what you’re covered for, should you ever need it.

This is particularly important when it comes to fertility cover

Some policies will cover assisted fertility procedures and appointments, whist other won’t. Sadly, a lot of what may be included in your insurance policy, and what may be excluded, will depend on where you are in the USA as each state has its own laws.

As of April 2021, 19 states have passed new laws that cover fertility insurance

Of these, 13 include coverage for IVF and 11 have fertility preservation laws for those with medically induced, or ‘iatrogenic”, infertility. However, even if your state isn’t included in these 19 states, if your employer is self-insured, they’re not bound by state insurance laws and therefore, your coverage may differ from that of the state you live in.

The 19 states with infertility coverage law are

  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Hawaii
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Montana
  • New Hampshire
  • New Jersey
  • New York
  • Ohio
  • Rhode Island
  • Texas
  • Utah
  • West Virginia

If you do live in one of these states, and you’re keen to understand if you’re covered by the state law (or if your employer might be self-insured, regardless of where you are), here’s some helpful questions to include in a conversation with your employer so that you know exactly where you stand…

Is your personal plan fully insured or self-insured?

Fully insured plans have to follow the insurance laws of the state, whereas self-insured polies are exempt from state law meaning that employers are more free to make decisions regarding their policies.

Is your plan a “greater than 25” plan or a “greater than 50” plan and so on?

Such plans mean that even in a state with infertility coverage laws, an employer with fewer than a set number of employees, i.e., 25 or 50 etc, they do not, by law, have to provide infertility coverage. In this case, some states may also limit coverage to the insurance markets of individual, small group or large group policies, so it’s always a good idea to check, even if you’re not planning on starting a family yet.

Is your plan written in the governed state?

This means checking that the policy your employer uses is written in and/or resides in the state that has the infertility insurance law.

Infertility and assisted fertility treatments come with enough stress, worry and upset

Being prepared by knowing what your health insurance policy covers you for will help to remove at least some part of the financial stress and worry.

Read more on health insurance cover for fertility in the USA here



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