Fertility laws in different States? (US)

posted 3 years ago in TTC
Post # 3
Member
1902 posts
Buzzing bee
  • Wedding: April 2012

Everyone I know has always paid out of pocket for in vitro fertilization.

Post # 4
Member
9137 posts
Buzzing Beekeeper
  • Wedding: November 2013 - St. Augustine Beach, FL

@sugarcube:  As far as I know infertility coverage was not part of the ACA (Obamacare) so it depends on whether your individual state passed a law and if they haven’t then it’s up to the insurance company to decide whether to cover it and how much to cover.  Unfortunately, most insurance companies don’t have infertility coverage and the few that do don’t cover much.  However, some companies (like Disney) offer really good infertility coverage so finding a job with a family friendly company like Disney may be your best option.

Post # 6
Member
9137 posts
Buzzing Beekeeper
  • Wedding: November 2013 - St. Augustine Beach, FL

@sugarcube:  If your employer is based in another state that doesn’t have the mandate then they do not have to provide the coverage.  Also, religious organizations do not have to provide the coverage.

Post # 8
Member
11668 posts
Sugar Beekeeper
  • Wedding: November 1999

@sugarcube:  I have no idea, but likely the insurance policy you are on was grandfathered in somehow.  I’d call your insurance company and ask.

Post # 9
Member
486 posts
Helper bee
  • Wedding: September 2012

It may mandate certain things but not everything. I know ny requires insurance companies to pay for things like HSG’s but there is no requirement to pay for iui or ivf.  Resolve.org had a big thing on what was covered in what state. I think it may still be there somewhere. 

Post # 12
Member
9137 posts
Buzzing Beekeeper
  • Wedding: November 2013 - St. Augustine Beach, FL

@sugarcube:  Call the insurance company directly and ask about the coverage.  They should be able to point you in the right direction.  If they can’t, then speak with HR because I’m sure they will be able to provide the excuse.

Post # 14
Member
486 posts
Helper bee
  • Wedding: September 2012

It could be possible that your company is self insured which would make it exempt. 

Post # 15
Member
1015 posts
Bumble bee
  • Wedding: June 2012

I think it depends on the insurance plan.  I’m in NY, and my first plan covered IUI, but not IVF.  I switched to a plan that provided partial coverage for IVF.  The way they explained the mandate to me is that although I don’t have my insurance’s Rx plan (I’m on a separate Rx plan thru DH), my health insurance has to cover the injectables for the IVF that they cover.  Or so they said.  Later they denied all of that.  Dealing with insurance is such a pain, but my meds were covered (though they might not be covered in the future, based on what they said, but my experience is no one has any idea what s/he’s talking about).

Post # 16
Member
1029 posts
Bumble bee
  • Wedding: January 2010

We moved to Connecticut last summer and immediately started the process of figuring out getting fertility testing. My insurance plan didn’t appear to have any coverage, but when we called and asked about it it was covered. Check out this site: http://www.rmact.com/affording-treatment/connecticut-state-infertility-insurance-mandate

There are a few exceptions to the mandate. You must be under 40. You have to have been insured for the previous 12 months in order for it to apply. It doesn’t have to be the same company or insurance or even state, it just has to be insurance coverage. Also, there are some companies which are exempt based on religion, etc. 

If I were you I would call your insurance provider. They will answer your questions, and you can let them know you are just planning ahead (if you feel weird about it).

We didn’t end up needing any testing or anything (found out we were pregnant right after our first appointment) but basically our insurance would have covered pretty much all of the testing, medications, and the specified number of cycles of IVF, IUI (see the website above).

Good luck!

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