It’s no secret that fertility treatments can require a large financial investment. However, there are ways you can make treatment more affordable. One of them is having insurance that covers fertility treatments. Although not all insurance policies offer fertility benefits, here are the steps you can use to find out more about your insurance under your employer.
IVF Coverage By State Mandate
If you are in a state that mandates employers to provide insurance coverage for IVF treatments, then you might be eligible for coverage. These states include Arkansas, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, and Rhode Island. Each of these states has laws requiring some degree of insurance coverage, although the requirements, coverage, and exceptions vary by state. Several other states, including California, Louisiana, Montana, Ohio, Texas and West Virginia, have a different kind of insurance mandate that might cover other fertility-related procedures such as diagnostic tests. To find out the fertility insurance coverage laws in your state, visit this website.
Fertility Benefits For Fully-Insured vs. Self-Insured Plans
Fertility benefit coverage also depends on whether your insurance plan is fully-insured, meaning plans follow state law, or self-insured, meaning the plan follows federal law and is exempt from state mandates.
For a fully-insured healthcare plan, your employer receives coverage from an insurance company that dictates what is covered under a standard benefits plan. Although the employer does not determine what is covered in this situation, the insurance company might still offer smaller, additional plans specifically for IVF or infertility called “IVF Riders” or “Infertility Riders.” Employers can add these mini-benefits plans to their standard benefits plan to offer coverage to employees.
With self-insured plans, which is more common among larger companies, employers themselves make decisions about what is covered under insurance plans. However, the downside of self-insured plans is that the employer does not have to follow state mandates for fertility benefits insurance coverage.
Fertility Benefits for Government or Military Employees
For individuals who are federal employees, active duty service members, military retirees, veterans, or covered by Medicare or Medicaid, the federal government provides insurance coverage.
For federal employees, coverage for assisted reproductive technology (ART) procedures and other infertility treatments may be covered by your insurance under the Federal Employees Health Benefits Program (FEHB). However, plan information may vary by state. To review your healthcare plan information, check the plan brochure for your insurance by state at this website.
If you or your spouse are in the armed services, there are specific care options that are covered depending on where you go. Certain military treatment facilities offer IVF treatments, while other types of infertility treatment and testing may be covered under your TRICARE insurance plan. Many additional fertility treatment centers across the country offer military discounts for their procedures. To find out if the treatment you’re looking for is covered, check this website and learn more about your TRICARE plan.
If you or your spouse is a veteran receiving healthcare under the Veteran’s Health Administration, then fertility services like IVF can be provided if a service-related disability makes it impossible to have a baby without the use of fertility treatments. You can learn more about whether you might qualify for these services on the VA women’s health services website, or from this press release.
If you are receiving health care under Medicare or Medicaid, you might qualify for coverage for certain fertility treatments depending on your situation. You can find out more about coverage under Medicare here. For Medicaid, there is no federal requirement that state programs must cover fertility testing or treatment, but states might cover other diagnostic testing to determine the causes of infertility.
Fertility Coverage for Self-Employed or Individual Plans
For those who are paying for their own health insurance, if you are living in a state with a fertility benefits insurance mandate, your plan likely mirrors the coverage of that mandate. Otherwise, most plans do not cover IVF.
If you are not sure what insurance plan you have, ask the human resources department of your employer. You can also learn more about your plan from your HR department using this workplace fertility coverage checklist. Regardless of your current insurance plan and benefits, you have many options available to make your fertility treatments more affordable, including asking your employer about the possibility of offering fertility benefits.