Does not include IVF. Does not require religious organizations to offer coverage. Fertility preservation coverage does not apply to Medi-Cal managed care health care service plan contracts. Employers who self-insure are exempt from the requirements of the law.
Failure to impregnate or conceive means the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a woman under the age of 35, or after 6 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a woman 35 years of age or older.
Conception resulting in miscarriage does not restart the month or 6-month clock to qualify as having infertility. Diagnosis of and treatment for infertility means the procedures and medications recommended by a licensed physician that are consistent with established, published, or approved medical practices or professional guidelines from ACOG or ASRM for diagnosing and treating infertility.
Standard fertility preservation services means procedures and services that are consistent with medical practices or professional guidelines published by ASRM or ASCO for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility. Coverage All individual and group health benefit plans issued or renewed in the state on or after January 1, shall provide coverage for the diagnosis of and treatment for infertility and standard fertility preservation services, including: 3 completed oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of ASRM, using single embryo transfer when recommended and medically appropriate.
The health benefits plan shall not impose: any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications covered under the health benefit plan; deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations on coverage for the diagnosis of and treatment for infertility and standard fertility preservation services that are different from those imposed on benefits for services covered under the health benefit plan that are not related to infertility.
Exceptions If the federal Department of Health and Human Services notifies the Division of Insurance, no later than July 30, , that the coverage provided for the individual and small group insurance markets constitutes an additional benefit that requires defrayal by the state pursuant to 42 U. Does not require religious organizations to provide coverage. Limits coverage to individuals who have maintained coverage under a policy for at least 12 months.
Coverage Lifetime maximum coverage of 4 cycles of ovulation induction. Lifetime maximum coverage of 3 cycles of intrauterine insemination. Each fertilization or transfer is credited as one cycle towards the maximum. Requires infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
Exceptions Does not require religious organizations to offer coverage. Iatrogenic infertility means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment. Such benefits must be provided to covered individuals, including covered spouses and covered non spouse dependents, to the same extent as other pregnancy-related benefits. Covered individual has not been able to obtain a successful pregnancy through reasonable effort with less costly infertility treatments covered by the policy, contract, or certificate, except as follows: No more than 3 treatment cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered.
If IVF is medically necessary, no cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered. For IVF services, retrievals are completed before the individual is 45 years old and transfers are completed before the individual is 50 years old. Coverage All individual, group and blanket health insurance policies that provide for medical or hospital expenses shall include coverage for fertility care services, including IVF and standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility.
Such benefits must be provided to the same extent as other pregnancy-related benefits and include the following: Intrauterine insemination. Assisted hatching. Cryopreservation and thawing of eggs, sperm, and embryos. Cryopreservation of ovarian tissue. Cryopreservation of testicular tissue. Embryo biopsy. Consultation and diagnostic testing. Fresh and frozen embryo transfers.
Ovulation induction. Storage of oocytes, sperm, embryos, and tissue. Surgery, including microsurgical sperm aspiration. A policy may not impose restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for required fertility care services, which are different from those imposed upon benefits for services not related to infertility.
Employers who self-insure or who have fewer than 50 employees are exempt from the requirements of the law. Stat Sections A Coverage is provided if the patient has been unable to obtain successful pregnancy through other infertility treatments covered by insurance.
Coverage One cycle of IVF. The coverage shall be provided to the same extent as maternity-related benefits. Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Standard fertility preservation services means procedures based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.
Coverage Group insurers and HMOs that provide pregnancy related coverage must provide infertility treatment including, but not limited to: diagnosis of infertility; IVF; uterine embryo lavage; embryo transfer; artificial insemination; GIFT; ZIFT; low tubal ovum transfer.
Each patient is covered for up to 4 egg retrievals. However, if a live birth occurs, two additional egg retrievals will be covered, with a lifetime maximum of six retrievals covered. An individual or group policy of accident and health insurance must provide coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee.
Exceptions Employers with fewer than 25 employees do not have to provide coverage. Does not require religious employers to cover infertility treatment. If HHS requires the State, pursuant to the ACA, to defray the cost of fertility preservation coverage, then fertility preservation coverage is no longer operative. Exceptions The law does not require insurers to cover fertility drugs, IVF or other assisted reproductive techniques, reversal of a tubal ligation, a vasectomy, or any other method of sterilization.
The patient is the policyholder or a covered dependent of the policyholder. The law requires every plan to communicate the availability of coverage to group contractholders. The law defines infertility, treatment for infertility and in vitro fertilization. The law clarifies that religious employers are not required to offer coverage for forms of treatment that are inconsistent with the organization's religious and ethical principles. The law was amended by Cal.
Infertility, in this case, refers to an otherwise healthy individual who is unable to conceive or produce conception or to sustain a successful pregnancy during a one-year period. Amended in to provide an exemption for coverage that is contrary to the religious beliefs of an employer or individual. Hawaii Rev. In order to qualify for in vitro fertilization procedures, the couple must have a history of infertility for at least five years or prove that the infertility is a result of a specified medical condition.
Coverage includes in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete sperm artificial intrafallopian tube transfer, zygote intrafallopian tube transfer and low tubal ovum transfer. Coverage is limited to four completed oocyte retrievals, except if a live birth follows a completed oocyte retrieval, then two more completed oocyte retrievals are covered.
Laws, P. The law does not require insurers to cover fertility drugs, in vitro fertilization or other assisted reproductive techniques, reversal of a tubal litigation, a vasectomy, or any other method of sterilization.
Acts, P. Insurance Code Ann. The law clarifies the conditions under which services must be provided, including a history of infertility of at least a 2-year period and infertility associated with one of several listed medical conditions. The law clarifies that an insurer or employer may exclude the coverage if it conflicts with the religious beliefs and practices of a religious organization, on request of the religious organization.
Regulations that became effective in exempt businesses with 50 or fewer employees from having to provide the IVF coverage. Laws, Chap. Health General Code Ann. Laws Ann. This law was amended in to change the definition of "infertility" to be a condition of an individual who is unable to conceive or produce conception during a period of one year if the female is under the age of 35, or during a period of six months if the female is over the age of If a person conceives but cannot carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the one year or six month period.
We don't know what will happen when we try to implant them in the future. But we celebrate every day with our son, knowing and appreciating the journey we took to have him. Monica Fike is a freelance writer living in San Diego with her husband and son. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message.
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