[Coloradobaby]

Hi my name is Leanne and i have struggled with infertility for almost 6 years and have spent so much money on trying to have a baby that we cannot afford to do any treatments now. And it makes me very sad to see myself and others have to not have as good of chances at getting pregnant as other states because Colorado does not offer fertility insurance.
This is what i want to do. I want to try and get Illinois fertility insurance laws on the ballot for Colorado to vote on in 2010. I do have the information on how to get this started but i wanted to get the word out now and maybe see if anyone wants to help get this done. Atleast if it is on the ballot then people can vote, if its not on the ballot then there will go another 2 years with no insurance coverage. Please let me know what you think!!

[chantalTTC]

Thank you for raising this issue and pushing for change. What sort of legislation would it be? Would it mean that insurance providers would be mandated to provide IF coverage? Or is this just for Colorado government employees? I'm interested in learning more...

[Coloradobaby]

It would mean that by law it insurance would need to be provided....not only for goverment but for everyone.
Here is Illionois law:

Illinois Law Mandating Insurance Coverage for Infertility
(Text from Illinois Insurance Website. Revised October 2008)

Infertility is a condition that strikes hundreds of couples in Illinois. Illinois law requires group insurance plans and health maintenance organizations (HMOs) to provide coverage for infertility. Here are the basic facts about the law.

Who Must Offer the Coverage?

Illinois law requires insurance companies and HMOs to provide coverage for infertility to employee groups of more than 25. The law does not apply to self-insured employers or to trusts or insurance policies written outside Illinois.However, for HMOs, the law does apply in certain situations to contracts written outside of Illinois if the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois. To determine if your HMO provides infertility benefits, you should contact the HMO directly or check your certificate of coverage.

Who is Covered?

To receive infertility coverage, you must:

• live in Illinois
• be covered by a fully insured Illinois group policy through an employer with more than 25 full-time employees
• have been unable to conceive after one year of unprotected sexual intercourse between a male and female or have been unable to sustain a successful pregnancy

What is Covered?

Illinois requires group insurance and HMO plans to cover the diagnosis and treatment of infertility the same as all other conditions. For example, they may not apply any unique co-payments or deductibles for infertility coverage. Benefits shall include, but not be limited to:

• testing
• prescription drugs
• artificial insemination
• invitro fertilization (IVF)
• gamete intrafallopian tube transfer (GIFT)
• intracytoplasmic sperm injection (ICSI)
• donor sperm and eggs (medical costs)
• procedures utilized to retrieve oocytes or sperm and subsequent procedures used to transfer the oocytes or sperm to the covered recipient are covered
• Associated donor expenses medical expense, including but not limited to physical examination, laboratory screening, psychological screening, and prescription drugs, are covered if established as prerequisites to donation by the insurer

What are the Limits?

Benefits for advanced procedures such as IVF, GIFT, ZIFT or ICSI are required only if you have been unable to attain or sustain a successful pregnancy through reasonable, less costly medically appropriate infertility treatments for which coverage is available under the policy.

The benefits for advanced procedures required by the law are four completed oocyte retrievals per lifetime of the individual, except that two completed oocyte retrievals are covered after a live birth is achieved as a result of an artificial reproductive transfer of oocytes. For example, if a live birth takes place as a result of the first completed oocyte retrieval, then two more completed oocyte retrievals for a maximum of three are covered under the law. If a live birth takes place as a result of the fourth completed oocyte retrieval, then two more completed oocyte retrievals for a maximum of six are covered. The maximum number of completed oocyte retrievals that can be covered under the law is six.

One completed oocyte retrieval could result in many IVF, GIFT, ZIFT or ICSI procedures. There is no limit on the number of procedures, including less invasive procedures such as artificial insemination. The only limitations are on the number of completed oocyte retrievals.

NOTE: Once the final covered oocyte retrieval is completed, one subsequent procedure (IVF, GIFT, ZIFT, or ICSI) used to transfer the oocytes or sperm is covered. After that, the benefit is maxed out and no further benefits are available under the law.

NOTE: Oocyte retrievals are per lifetime of the individual. If you had a completed oocyte retrieval in the past that was paid for by another carrier, or not covered by insurance, it still counts toward your lifetime maximum under the law.

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What is Not Covered?

Your group insurance or HMO plan does not have to pay for:

• costs incurred for reversing a tubal ligation or vasectomy
• costs for services rendered to a surrogate, however, costs for procedures to obtain eggs, sperm or embryos from a covered individual shall be covered if the individual chooses to use a surrogate and if the individual has not exhausted benefits for completed oocytes retrievals
• costs of preserving and storing sperm, eggs and embryos
• costs for an egg or sperm donor which are not medically necessary; any fees for non-medical services paid to the donor are not covered under the law
• experimental treatments
• costs for procedures which violate the religious and moral teachings or beliefs of the insurance company or covered group

Illinois Infertility Insurance Mandate Exact text

Last Updated ( Saturday, 22 November 2008 )

[tko6666]

Wow, it sounds interesting! I live in CO and would love to see this passed. Not sure what I can do, but I would love to help! Terri

[7LMA7]

Hey Coloradobaby, I too live in CO and have been wishing we could get IF treatments covered too. Let me know how I can help.
LMA

[lookingforhope]

My husband and I also suffer from infertility. We were diagnosed with non-specific male factor infertility. Unfortunately soon after we moved to Colorado, which does not require insurance companies to cover infertility. Therefore we are at a standstill since we can't afford to pay for the expensive IVF + ICSI treatments we need. Would love to help get this on the ballot in 2010. Let me know how I can help.

[Coloradobaby]

Just so everyone knows i have not forgot about you. I am still planning on trying really hard to get this on the ballott for 2010 i unfortunarely cannot do much until 2010 gets here!!