Infertility Insurance Coverage

What Benefit Can You Expect From Infertility Insurance Coverage?

Some couples try for years to have a baby but can't achieve a successful pregnancy. Some turn to infertility treatments, including in-vitro fertilization. While undergoing treatment to achieve pregnancy, a special type of insurance, called infertility insurance, may be available to help cover the very expensive costs of trying for a pregnancy, often with the help of special technology. The good news is that there are some states where this insurance is actually required. Unfortunately, it can be confusing to understand what this product is and what it covers. In some cases, not every couple is eligible.

So what do couples or anyone trying to get pregnant need to know about infertility insurance coverage? An important first step is to check state laws. The American Society of Reproductive Medicine and similar websites can provide a detailed list of state laws and requirements.

A critical fact is that state laws vary greatly (if infertility insurance is even offered). In Illinois, for example, this insurance is not available unless a policy covers more than 25 people. In that case, people who haven't been able to achieve a pregnancy within a year or who have a miscarriage or other problem during the pregnancy would be allowed to get infertility insurance coverage, assuming they were covered under the proper policy with the required number of people enrolled. In contrast, Montana seems to provide infertility coverage for all those in HMOs. Others may be excluded.

As the above two examples indicate, state laws vary widely. Of course, some of those seeking infertility treatments may have to buy their own insurance. Whether going through a state plan or private health insurance plan, some basic questions can help narrow down the actual benefits offered by infertility insurance coverage - as well as the costs. Also, be aware that there may be age limits on coverage, making it difficult for women over 40 to find any reasonably priced insurance. In some states, single women are excluded from getting any benefits.

Those who are eager to try an in-vitro fertilization should find out what meets the definition of infertility in their state (it can be up to two years or longer in some states). They should also ask if individuals or couples need to be in an insurance plan with a minimum number of enrollees. Another important issue? Finding out what is covered and the limits of the insurance plan. Some infertility insurance covers diagnostic tests and any related surgeries, medications, in vitro fertilization (IVF) and more.

In some cases, the infertility must be tied to very specific medical conditions such as endometriosis, fallopian tube issues or low sperm count. Just as insurance coverage varies by state, so do the conditions which warrant acceptable infertility conditions.

Because state laws do vary so widely, it is hard to get an exact figure for the cost of infertility insurance coverage. Lifetime maximum benefits may be as little as $15,000 (not enough to cover one in-vitro procedure) or as much as $100,000. Again, it is important to note that this insurance often comes with very strict requirements, forcing single women or couples to decide whether to wait for up to 2 years to be eligible for insurance or to seek private infertility insurance coverage. State laws may also not require insurers to offer coverage for infertility.

 

 

 

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