Since January some
House Bill 1008, which passed this spring, requires state-regulated health plans for large employer groups to cover the full range of infertility treatment services. People with other types of health insurance may have some coverage, but are more likely to run into limitations.
Here are answers to some frequently asked questions about the new law:
How do I know if this applies to me?
Check your insurance card first. If it says “CO-DOI” anywhere on the card, your insurance plan is state-regulated. If not, the new mandate does not apply to you. That was also the case with other state-imposed coverage requirements in recent years, such as the cap on out-of-pocket insulin costs.
Only large group plans regulated by
Religious organizations are allowed to ask their insurance plans not to cover certain fertility services they object to, but are required to notify staff if they do.
If you are covered by Medicaid or another form of government-provided insurance, the mandate does not apply to you.
I’m covered. What does this mean?
From January you have cover for fertility services that are considered suitable under
For people who need IVF, insurance will need to cover three egg retrievals and an unlimited number of embryo transfer attempts. IVF involves stimulating the ovaries with drugs to produce more eggs, which are removed and fertilized outside the body with sperm from a partner or donor. They are then transferred into the body, hoping to lead to pregnancy and a healthy birth.
Plans are not allowed to place limits on drugs used for infertility beyond what they have for other drugs, and they cannot set a separate deductible or require higher out-of-pocket payments. However, this still leaves room for variation: A household with a high-deductible insurance plan will almost certainly pay more out-of-pocket for infertility care than a household that pays higher monthly premiums in exchange for lower costs when uses care.
The mandate uses
My plan is not under the mandate. Do I have any coverage?
Some infertility services are considered a significant health benefit
They should not cover IVF or egg freezing to prevent infertility. It’s not common, but some companies choose to add more coverage for infertility, so check with your insurance provider before starting treatment.
You may have additional coverage at some point in the future if
Why do only some plans need federal approval?
For individual and small group plans,
The 2022 bill basically gutted state-regulated plans (which don’t require federal approval) to give some people coverage starting in January. The insurance department is still working to convince HHS that it should approve coverage of more fertility services for people with individual and small group insurance.
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