What does a "Mandate to Cover" mean? It's a law that requires insurance carriers to provide a certain kind of benefit. In this case, insurers in the following states must provide some level of fertility treatment benefit in every policy and include the cost in the policy premium. See the specific states below for details and limitations.

If you need help understanding these mandates, feel free to ask to speak with an insurance benefits specialist at Fertility LifeLines™ at 1–866–LETS–TRY (1-866-538-7879).

For more information about any of the mandates listed here (and to determine if your state has recently changed or enacted an infertility insurance mandate), you should contact your state's Department of Health or Department of Insurance.

Arkansas

Mandates insurance carriers that provide maternity–related benefits to cover IVF. Allows insurers to impose a lifetime benefit cap of $15,000. Health maintenance organizations are exempt from the law.

Hawaii

Mandates insurance carriers that provide pregnancy–related benefits to cover one cycle of IVF, only after several conditions have been met.

Illinois

Mandates insurance carriers that provide pregnancy–related benefits to cover the diagnosis and treatment of infertility, including various ART procedures, but limits first-time attempts to four complete oocyte (egg) retrievals, and second births to two complete oocyte retrievals. Insurance carriers are not required to provide this benefit to businesses (group policies) of 25 or fewer employees.

Louisiana

Mandates insurance carriers to cover the "diagnosis and treatment of correctable medical conditions." Thus, insurers may not deny coverage for treatment of a correctable medical condition to someone solely because the condition results in infertility. Coverage is not required for fertility drugs; in vitro fertilization or any other assisted reproductive technique; or reversal of tubal ligation, a vasectomy, or any other method of sterilization.

Maryland

Mandates insurance carriers that provide pregnancy–related benefits to cover IVF after a two–year wait following diagnosis, with no wait required for certain diagnoses. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees. Religious organizations can choose not to provide coverage based on their religious views. A carrier may limit IVF benefits to three attempts per live birth, not to exceed a lifetime maximum benefit of $100,000.

Massachusetts

Mandates insurance carriers that provide pregnancy–related benefits to cover comprehensive infertility diagnosis and treatment, including ART procedures.

Montana

Mandates HMOs (but not other types of insurers) to cover infertility treatment as a basic health care service. The law does not define "infertility services", and some HMOs exclude IVF.

New Jersey

Mandates insurance carriers that provide pregnancy–related benefits to cover comprehensive diagnosis and treatment of infertility, including assisted reproductive technology procedures, but limits attempts to four complete oocyte (egg) retrievals per lifetime. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees.

New York

Mandates coverage for the diagnosis and treatment of correctable medical conditions. Requires coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded, including IVF, GIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include prescription coverage must cover drugs approved by FDA for use in diagnosis and treatment of infertility (including Ovulation Induction (OI)). The law does not apply to HMOs.

Ohio

Mandates HMOs (but not other types of insurers) to cover infertility treatment as a "preventative" benefit. The treatment must be "medically necessary," and the Ohio Department of Insurance has ruled that GIFT, ZIFT and IVF are not medically necessary.

Rhode Island

Requires insurers and HMOs that provide pregnancy–related benefits 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.

West Virginia

Mandates HMOs (but not other types of insurers) to cover infertility treatment as a preventative benefit. The law does not define "infertility treatment" and HMOs have interpreted the term as excluding IVF.

States with a "Mandate to Offer."

The following states have a Mandate to Offer. That's a law that requires insurers to offer coverage that employers may or may not choose to purchase. Currently, three states have Mandates to Offer infertility treatment. Insurers in these states must offer employers a policy that provides coverage of infertility treatment. That doesn't mean that an employer has to purchase the policy. Employers can choose between a policy covering fertility treatment and one that doesn't.

If you have questions about your state or your policy, ask to speak with an insurance benefits specialist at Fertility LifeLines™ at 1–866–LETS–TRY (1-866-538-7879).

California

Mandates insurance carriers to offer group policyholders coverage of infertility treatment, excluding IVF but including GIFT. (Group health insurers covering hospital, medical or surgical expenses must let employers know infertility coverage is available.)

Connecticut

Mandates insurance carriers to offer coverage of comprehensive infertility diagnosis and treatment, including IVF procedures, to group policyholders.

Texas

Mandates insurance carriers that provide pregnancy–related benefits to offer coverage of infertility diagnosis and treatment, including IVF, to group policyholders.


* American Society for Reproductive Medicine. Infertility: An Overview. 2003.