Is IVF Covered by Insurance Companies?

When a couple experiences infertility they are faced with many hard decisions. Reproductive medicine can be very costly and the insured is very fortunate if their policy covers the needed treatments. Only 13 states mandate the coverage of some fertility treatments:

• Arkansas requires health insurance companies to cover the cost of IVF up to a lifetime maximum of $15,000. HMOs exempt.
• California requires certain insurers to offer coverage of infertility diagnosis and treatment. Group insurers must inform employers of this availability; however law does not require the employer to offer the plans.
• Connecticut requires individual and group health plans to cover medically necessary infertility procedures, including IVF, IUI, Embryo transfer, GIFT, and ZIFT to a specific maximum.
• Hawaii requires certain insurance providers offer holders a one time benefit for IVF costs already incurred.
• Illinois law requires policies covering 25 or more people and offering pregnancy benefits must cover the cost of the diagnosis and treatment of infertility including IVF, Embryo transfer, GIFT, ZIFT, ICSI.
• Maryland law requires that providers covering pregnancy also cover out patient costs associated with IVF treatment.
• Massachusetts law requires providers covering pregnancy also cover the medically necessary cost of fertility treatments, including IVF, IUI, GIFT, ZIFT and sperm and egg retrieval.
• Montana law requires HMOs to cover all preventable healthcare treatments including fertility. It does not however, define infertility nor specify what treatments should be covered.
• New Jersey law requires group policies covering 50 or more people covering pregnancy also cover the cost of infertility treatments including surgery, including IVF, IUI, GIFT, ZIFT and sperm and egg retrieval.
• New York law stipulates that private and group plans issued within the state cover the treatment of correctable conditions, including infertility. It excluded IVF, ZIFT, and GIFT.
• Ohio law mandates insurers to cover all basic health care expenses including medically necessary infertility treatments, though it does not define medically necessary.
• Rhode Island insurers coving pregnancy must also cover the medically necessary treatments for infertility.
• Texas insurers covering pregnancy must offer coverage for IVF. Employers must be informed of these benefits but it is not mandated that they offer them.
• West Virginia HMOs must cover all basic health care services including infertility treatments but does not define infertility or what treatments must be covered.

At this time, most policies do not cover the full cost of reproductive medicine as it is viewed as elective. However as health care continues to evolve this may change as many fertility treatment centers and patients advocate for inclusion. Currently, most insurance policies which include infertility treatments only cover the cost of treatments and visits to the fertility treatment center until the point of needing in vitro fertilization (IVF) treatments. Most fertility treatment centers have someone that works to assure that the insured is utilizing available coverage however, those considering infertility treatments should be proactive and research the laws in their state, and know their insurance policy.