Coverage and Use of Fertility Services in the U.S.
Appendix 1: Private Insurance
| Appendix 1: States That Require Private Insurance Coverage of Infertility Services | |||
| Infertility coverage required: (As of May 2020) |
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| State (Statute year) | By which insurers? | For which indications? | For which treatments? |
| AR
(1987, 2011) |
Included: all individual and group insurers*
Excluded: HMOs; self-insurers |
Eligible: Infertility due to male factor, endometriosis, blocked fallopian tube (or unexplained for 2 years)
Ineligible: if egg/sperm not from spouse |
Covered: IVF (lifetime max $15,000)
Not covered: Fertility preservation for iatrogenic infertility |
| CA
(1990) |
Mandate to offer, not cover: group insurers must let employers know coverage for diagnostic tests and some treatment is available (excludes IVF and fertility preservation), but employers do not need to provide coverage to employees | ||
| CO
(Effective 2022) |
Passed House Bill 20-1148 in April 2020 to mandate coverage for infertility diagnosis and treatment, and fertility preservation for iatrogenic infertility. Applies to all individual and group health benefit plans renewed or issued after January 1, 2022, but religious employer may request exemption. | ||
| CT
(1989, 2005) |
Included: Health insurance organizations
Excluded: Persons on plan for <12 months; religious employers; self-insurers |
Eligible: Infertility for 1 year or iatrogenic infertility | Covered: diagnosis/treatment (including medications, IUI, IVF), fertility preservation for iatrogenic infertility
Not Covered: Lifetime max of 4 cycles of ovulation induction, 3 cycles of IUI |
| DE
(2018) |
Included: Individual and group insurers, HMOs **
Excluded: <50 employees; religious employers; self-insurers |
Eligible: Infertility or iatrogenic infertility | Covered: consultation, diagnostics, medications, IUI, IVF and other treatments; fertility preservation for iatrogenic infertility
Not Covered: Egg retrieval after age 45, >6 egg retrievals, surrogacy compensation, reversal of voluntary sterilization |
| HI
(1989, 2003) |
Included: Individual and group insurers
Excluded: self-insurers |
Eligible: 5 years of unexplained infertility, OR infertility due to male factors, endometriosis, blocked/ removed fallopian tubes
Ineligible: if egg/sperm not from spouse |
Covered: 1 cycle of IVF, all outpatient expenses arising from IVF |
| IL
(1991, 1996) |
Included: Group insurers and HMOs*; individual insurers for iatrogenic infertility
Excluded: <25 employees; religious employers; self-insurers |
Eligible: 1 year of infertility or iatrogenic infertility | Covered: Diagnostics, IUI, IVF, and other treatments; fertility preservation for iatrogenic infertility
Not Covered: More than 6 egg retrievals |
| MD
(2000) |
Included: Individual and group insurers*
Excluded: <50 employees; religious employers; self-insurers |
Eligible: Infertility due to male factor, endometriosis, blocked/removed fallopian tubes (or if unexplained for 2 years) | Covered: 3 cycles of IVF per life birth (lifetime max $100,000); fertility preservation for iatrogenic infertility
Not Covered: Storage of sperm/eggs |
| MA
(1987, 2010) |
Included: All insurers and HMOs*
Excluded: self-insurers |
Eligible: Infertility for 1 year if age <35, 6 months if 35+ | Covered: IUI, IVF, cryopreservation and others (no lifetime limit on cost or cycles)
Not Covered: Surrogacy, reversal of sterilization |
| MT
(1987) |
Included: HMOs
Excluded: all other insurers |
Eligible: No definition of infertility | Covered: must cover “infertility services,” does not define which |
| NH
(2020) |
Included: Group insurers***
Excluded: Small business health options program; extended transition to ACA- programs; self-insurers |
Eligible: Ability to become/cause pregnancy is impaired | Covered: Diagnostics, treatment including medications, egg/sperm procurement; fertility preservation for iatrogenic infertility
Not Covered: reversal of voluntary sterilization; some aspects of care if surrogate involved |
| NJ
(2001) |
Included: Group insurers; HMOs; State Health Benefits Program; School Employees Health Benefits Program*
Excluded: <50 employees; religious employers; self-insurers |
Eligible: Infertility for 1 year if age <35, 6 months if 35+; single female unable to conceive with 12 IUIs if <35, 6 IUIs if >35; persons involuntarily sterilized
Ineligible: >46 years old |
Covered: diagnostics, medications, surgery, IUI, IVF, and other treatments (max 4 egg retrievals per lifetime)
Not Covered: reversal of voluntary sterilization; cryopreservation |
| NY
(1990, 2002, 2020) |
Included: Large group insurance market for IVF (>100 employees); all commercial markets for cryopreservation
Excluded: Individual and small group markets for IVF; self-insurers |
Eligible: Infertility for 1 year if age <35, 6 months if 35+
Ineligible: |
Covered: diagnostic procedures, medications, 3 cycles of IVF; fertility preservation if iatrogenic infertility
Not Covered: surrogacy, reversal of elective sterilization |
| OH
(1991) |
Included: HMOs
Excluded: all other insurers |
Eligible: No definition of infertility | Covered: diagnostic and exploratory procedures to correct cause for infertility (endometriosis, blocked fallopian tube, testicular failure)
Not Covered: IVF and other treatments |
| RI
(1989, 2007) |
Included: Insurers and HMOs*
Excluded: Self-insurers |
Eligible: Infertility for 1 year; iatrogenic infertility
Ineligible: women aged <25 of >42 (unless for fertility preservation) |
Covered: diagnostics and treatment, including IVF; fertility preservation for iatrogenic infertility (up to 20% copay allowed)
Not Covered: >$100,000 on treatment |
| TX
(1987, 2003) |
Mandate to offer, not cover: Group insurers must offer IVF as a benefit, employers can choose whether or not to include it. If choose to include, must be egg/sperm from spouse. | ||
| UT
(2014) |
Included: Insurers*
Excluded: Self-insurers |
Eligible: no definition of infertility; persons wishing to adopt | Covered: $4000 adoption indemnity, can also be used for infertility treatment |
| WV
(1995) |
Included: HMOs
Excluded: all other insurers |
Eligible: no definition of infertility | Covered: must cover “infertility services,” does not define which |
| NOTES: *Insurers must cover if they also provide pregnancy-related benefits. ** Must cover infertility services to same extent as other pregnancy-related services. ***Must cover if also provide medical/hospital expenses. AL, AK, AZ, CO, DC, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MN, MS, MO, NE, NV, NM, NC, ND, OK, OR, PA, SC, SD, TN, VT, VA, WA, WI, and WY do not require private insurers to cover infertility treatments. SOURCES: NCSL. State Laws Related to Insurance Coverage for Infertility Treatment. 6/12/2019; American Society for Reproductive Medicine (ASRM). State Infertility Insurance Laws; Resolve. Infertility Coverage by State; Colorado House Bill 20-1158 |
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