Infertility insurance coverage

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Specializes in Only the O.R. and proud of it!.

What is infertility insurance coverage like in the various states?

Here in Illinois, it is mandated by law that employers offer infertility coverage to their employees, UNLESS:

1) less than 50 employees

2) Employer is non-profit and faith-based that does not believe in assistive conception.

This is a true statement, I hope - I haven't looked it up in a while.

Also, I have heard that there may be some legislation going on that may drastically change all this, and mandate coverage for all with no exceptions.

Has anyone heard of anything about this?

I sent a letter to my congressman and state rep, but they (their staff, that is) are still researching it.

Your help and information is appreciated.

(As you may guess, I work for a faith-based hospital)

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Specializes in Only the O.R. and proud of it!.

OK - I was a little off - my memory must be failing!!

Link:

http://www.idfpr.com/DOI/HealthInsurance/infertility.asp

I was pretty close, though!!

You can see the law for yourself at the above link.

The number of emplyees is 25 (not 50) and the faith thing still applies, there are other requirements and restrictions, as you will see.

Sorry for any mis-information on my part...

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I don't think there is any mandate in Texas.

We went through IVF and paid cash. All 20K of it. OUCH !

I learned of women (through an online message board) who temporarily went to work at Starbucks because they have *wonderful* infertility coverage.

There seems to be an unusually high # of infertility problems among nurses...or it could just be that so many of us are female. Good luck and I wouldn't wait around on hearing from your congressman.

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In Virginia, it is not a mandated service. There are some companies that choose to cover of course, but probably more that do not. And some will do a broader cost share type of thing-such as 50/50 (ins pay for 50% and individual resp for other 50%)

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I don't necessarily agree with forcing faith-based businesses to provide assisted contraception coverage to it's employees. To me, if someone is running a faith-based business, then they have every right to practice in accordance with that faith. To me, to do otherwise, would be hypocritical, and a person can always ask to review benefits before taking a job.

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I'm in CA and there is no requirement, it's up to each insurance company. A few years ago my husband and I looked into fertility medicine, and my insurance at the time did not cover it at all, not in any way, shape or form. My husband's insurance, on the other hand, covers everything up to A.I. Beyond that it wasn't covered. I did start the workup and to get my insurance to cover it, the doctor billed it as dysmenorrhea treatments.

My husband's coverage is great: they pay for medications, all the ultrasounds, egg harvesting, and A.I.

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Specializes in Cardiac.

I learned of women (through an online message board) who temporarily went to work at Starbucks because they have *wonderful* infertility coverage.

Seriously? Starbucks? Very interesting...

Here in Az we don't have infertility mandated. Bummer... I get to pay everything out of pocket.

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Specializes in Only the O.R. and proud of it!.
I don't necessarily agree with forcing faith-based businesses to provide assisted contraception coverage to it's employees. To me, if someone is running a faith-based business, then they have every right to practice in accordance with that faith. To me, to do otherwise, would be hypocritical, and a person can always ask to review benefits before taking a job.

I see your point. But, from my point of view, the institution is forcing their beliefs on ME!!

Also, I'm talking about CONCEPTION not CONTRAception. Common mistake, or mis-speak. I know what you meant!!! And if the Doc writes a note (or calls the insurance) and informs them that an oral contraceptive is for dysmenorrhea or some other type of medical problem (and not for contraception), they WILL cover it!!

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Specializes in home health, peds, case management.

it is important to note when researching state mandates that self insured groups (usually large employers) are not required to adhere to state mandates, only federal mandates. most health systems are in fact self insured/aso, so if you have/don't have infertility coverage, it is likely the decision of the employer, not the insurance company. not that this makes things any cheaper, or easier.

best wishes to all!

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Specializes in ICU, L&D, Home Health.

Some states mandate that all fertility treatments not considered experimental must be covered by insurance (this can include meds to stimulate ovulation like Clomid, IUI, and testing.) Here in Ohio, thankfully, that's the case. Our insurance paid for my husband's semen analysis and my Clomid. If we end up doing IUI or having to use a different med to stimulate my cantankerous ovaries, it will be covered as well. Most insurance companies consider IVF to be experimental, and therefore do not cover it (this despite its being the only effective treatment for certain infertility conditions, as well as a 30 year track record.) Occasionally a business will elect to provide coverage for one or more IVF cycles. I have a friend whose generous company will pay for up to three cycles of IVF. That is a rarity though.

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cantankerous ovaries,

:lol2: :lol2: :lol2: :lol2:

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