Insurance Coverage for Infertility Laws
Похоже, что часть штатов оплачивает.State Laws Related to Insurance Coverage for Infertility Treatment
Updated March 2012
Approximately 12 percent of U.S. women of childbearing age, about 1 in 8 couples, have received assistance for infertility. Usually, infertility is defined as the absence of conception after at least one year of regular, unprotected intercourse. Common methods of infertility treatment include various insemination techniques and hormone therapy to stimulate egg production. Assisted reproductive techniques (ART) are procedures in which pregnancy is attempted through the use of external means; for example, eggs are fertilized outside the womb and then placed into a woman's uterus through in vitro fertilization (IVF). More than 61,000 babies were born in the United States in 2008 as a result of non-donor ART procedures. The Centers for Disease Control and Prevention estimate that ART accounts for slightly more than one percent of total U.S. births.
Although advances in infertility treatment have helped thousands of couples become parents, the procedures are not without controversy. Such procedures can be quite expensive— according to RESOLVE on average each cycle of IVF costs $8,158 plus $3,000 to $5,000 for medications—and debate exists about whether insurance plans should cover them. Studies have shown that assisted reproductive technologies have contributed to an increase in multiple births, which have a higher rate of prematurity than single births. In 2007, 8.2 percent of all newborns were low birthweight (less than 5.5 pounds), the highest percentage since the early 1970s. Preterm births cost society at least $26 billion per year.
Since the 1980s, 15 states—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Thirteen states have laws that require insurance companies to cover infertility treatment. Louisiana and New York prohibit the exclusion of coverage for a medical condition otherwise covered solely because the condition results in infertility. Two states—California and Texas—have laws that require insurance companies to offer coverage for infertility treatment. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California, Louisiana, and New York have laws that specifically exclude coverage for the procedure.
Massachusetts Infertility Insurance Mandate
Massachusetts Infertility Insurance Mandate
Massachusetts is one of 15 states that has a state mandate in place that requires insurance plans to offer coverage or provide coverage for IVF costs and fertility treatments. Massachusetts’ law on infertility insurance coverage is found in Chapters 175 and 176 of the Annotated Laws of Massachusetts, as well as 211 CMR 37.00 of the Division of Insurance Regulations.
Massachusetts law on infertility insurance coverage was first enacted in 1987. According to the Massachusetts infertility insurance law , health insurance companies and health maintenance organizations (HMOs) that cover pregnancy-related benefits must also provide coverage for the medically necessary expenses for infertility diagnosis and fertility treatment costs, including IVF costs. The Massachusetts fertility treatment insurance law was amended in 2010 to redefine the definition of infertility.
The law on fertility treatment insurance redefined the definition of infertility as an individual who is “unable to conceive or produce conception” during a period of one year if the woman is under the age of 35. If the woman is over the age of 35, the period of time is only six months.
Massachusetts law on coverage for fertility treatment costs clarifies the fertility treatments that will be covered. Covered fertility treatments include artificial insemination (AI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) , sperm, egg, or inseminated egg retrieval, intracytoplasmic sperm injection (ICSI) for male infertility, and zygote intrafallopian transfer (ZIFT). The Massachusetts infertility insurance mandate also specifies that insurance companies cannot impose limitations, restrictions, or exclusions on coverage for fertility treatment drugs that are different from those imposed on other prescription drugs.
Massachusetts Insurance Coverage for Infertility
The Massachusetts Infertility Mandate requires that insurance companies provide coverage for certain fertility procedures, but it does not set the level of coverage. When looking at fertility treatment costs, it is important to calculate applicable co-pays as well as prescription drug plan reimbursement.
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