Infertility Insurance

Infertility Insurance – Limited and Costly

Sad but true – the high cost of infertility treatment often prevents infertile couples from becoming parents. Most health insurance policies exclude infertility treatment entirely — only 25% of employee health insurance policies cover infertility treatment.

Employee Health Plans

Couples who are covered by employer-sponsored health insurance often find coverage inadequate due to exclusions and treatment limits in most of those policies:

- Typical infertility insurance covers only the most inexpensive treatments

- Coverage is usually limited to a specific number of treatment cycles, usually three to five cycles, while many more cycles may be required

- Drug treatment, especially the more expensive injectable medications (cost could be in excess of $1,000 per month), may not be covered at all

- Sperm donations and egg donations are rarely included

Laws

In the US and internationally, laws have been passed to address the economic hardship faced by infertile couples. At last count, these 13 US states have laws requiring certain employers to cover some, but not all, costs of infertility treatment:
- California
- Texas
- New York
- Massachusetts
- Ohio
- New Jersey
- Connecticut
- Montana
- Arkansas
- Maryland
- West Virginia
– Rhode Island
- Hawaii
- Illinois

But those laws usually do not apply to employers with self-funded insurance plans and to smaller employers with fewer than 50 employees.

Other (non-Employee) Health Insurance
Plans available directly to the public may or may not cover infertility treatment. And even the most generous include limits and exclusions that can leave couples with thousands of dollars in medical bills:
- Less than 50% of plans pay for traditional infertility treatment
- Less that 20% of plans cover in vitro fertilization (IVF)

The Health Care Reform Law of 2010 – (ObamaCare)

US health care will change in many ways as the new law becomes effective over a period of years. Its effect on cost and coverage of infertility is unclear. A CNN question and answer session on March 25, 2010 includes this:

    Question:

Over 30 million couples suffer from infertility in the United States. Most insurers will not cover this problem. Will the new bill finally address this as a significant health problem?

    Answer:

There is nothing in the bill regarding this issue. One benefit is that insurance companies cannot deny coverage to couples who suffer from infertility because it was deemed a pre-existing condition. However, in terms of covering infertility treatments or in-vitro fertilization, none of that is made mandatory under the bill for insurance companies.

A Google search of the 2000+ page actual law as passed by Congress, signed by the president and posted online revealed:
- No mention of infertility, fertility, in vitro fertilization, assistive reproduction technology
- Flexible spending accounts, which have been used by couples for infertility treatment, are being capped at $2,500 beginning in 2011

It is possible that other parts of the Health Care Reform Act, such as the pre-existing condition rules, will provide some benefit for some infertile couples, but that is not clear at this time.