Insurance State-to-State

As you no doubt already know, health insurance coverage is a complex and ever-changing landscape. Not all health insurers cover the costs of infertility treatments, and when they do, the benefits can range widely.

Coverage not only varies from plan to plan and company to company, but also from state to state, as some state laws require coverage by health insurers, whereas others do not. A little less than one-third of the states have mandated coverage (i.e., the state legislature has passed a law requiring insurers to cover some forms of infertility treatments). New England residents are perhaps more fortunate than Americans in other regions in that half of the states in which RSC offers services have mandated coverage.

Below is information as to coverage in New England states, according to the American Society for Reproductive Medicine (October 2005). However, this information is subject to change without notice, and we do not guarantee its accuracy. Therefore, each patient is wise to research his or her plan coverage extensively in advance either online or by calling the insurer or benefits representative, or both.

For other financing options, be sure also to visit our financing page. RSC is pleased to offer several innovative ways to help patients manage the cost of treatments.

Massachusetts

This state's law requires health maintenance organizations and insurance companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment. The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."

Benefits covered include:

• Artificial insemination;
• In vitro fertilization;
• Gamete Intrafallopian Transfer;
• Sperm, egg and/or inseminated egg retrieval (GIFT), to the extent that those costs are not covered by the donor's insurer;
• Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility; and
• Zygote Intrafallopian Transfer (ZIFT).
  

Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs. (Annotated Laws of Massachusetts, Chapters 175,§ 47H; 176A,§8K;176B,§4J; and l76G,§4, 211 CMR 37.00).

Rhode Island

The Rhode Island law requires insurers and HMO's that cover pregnancy services to cover the cost of medically necessary expenses of diagnosis and treatment of infertility. The law defines infertility as "the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year." The patient's co-payment cannot exceed 20 percent. (Rhode Island General Laws (§ 27-18-30, 27-19-23, 27-20-20 and 27-41-33).

Connecticut

Individual and group health insurance policies are required to cover medically necessary expenses for infertility diagnosis and treatment. Infertility is defined as the inability to conceive or sustain a successful pregnancy during a one-year period.

Covered treatments include ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, GIFT, ZIFT, and low tubal embryo transfer. Coverage is limited to individuals who have maintained coverage under the policy for at least a year.

Some additional limitations apply:

1. The covered individual must be under 40 years of age;
2. There is a life-time coverage maximum of four cycles of ovulation induction, three cycles of IUI, and two cycles of IVF, GIFT, ZIFT, or low tubal embryo transfer (with not more than two embryo transfers per cycle);
3. Covered treatments must be performed at facilities that conform to standards and guidelines developed by ASRM or SREI. 
   

Individuals seeking coverage must disclose to their insurance carrier any prior infertility treatments for which they received coverage under a different insurance policy. Religious employers are permitted to exclude coverage for treatments that are contrary to their bona fide religious tenets. (Public Act No.05-196)

The states of Maine, New Hampshire and Vermont do not have mandated coverage.