Page Title

At present there are 14 states that either mandate to offer or mandate to cover infertility
diagnosis and treatment, as summarized, below.

A “mandate to offer” means there is law that requires health insurance companies to at least
offer to cover infertility diagnosis and treatment.

A “mandate to cover” generally means that health insurance companies must provide
infertility diagnosis and treatment for all policyholders.

STATE

MANDATE TO
OFFER

MANDATE TO
COVER

COMMENTS

ARKANSAS

Excludes HMO's. Lifetime benefit cap at
$15,000

CALIFORNIA

Must offer infertility diagnosis and treatment
but excludes IVF.

CONNECTCIUT

Mandates diagnosis and treatment of
infertility up to 2 cycles of IVF. Must be
under 40 years. No more than 2 embroys
implanted per cycle.

HAWAII

Restrictive but covers one cycle of IVF

ILLINOIS

Comprehensive including up to four IVF
procedures (two for second birth). Group
policies with <25 employees exempt.

MARYLAND

Some diagnoses require waiting period but
does cover IVF. Group policies with <50
employees exempt.

MASS.

Comprehensive-covers IVF. No limit on
number of times and no lifetime cap.

MONTANA

Mandates HMO's to cover infertility.

NEW JERSEY

Mandates carriers that provide pregnancy
related benefits to cover ART procedures,
limited to four egg retrievals per lifetime.

NEW YORK

Mandated to cover correctable medical
conditions, regardledss of fertility or infertility
diagnosis.

OHIO

Mandates HMO's to cover infertility.

RHODE ISLAND

Comprehensive, includes ART, larger
co-payment allowed.

TEXAS

Must offer infertility diagnosis and treatment
and includes IVF

WEST VIRGINIA

Mandates HMO's to cover infertility.

Arkansas
This law requires all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF) Health maintenance organizations, commonly called HMOs, are exempt
from the law.
Patients need to meet the following conditions in order to get their IVF covered:
•        The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
•        The patient's eggs must be fertilized with her spouse's sperm;
•        The patient and her spouse must have at least a two-year history of unexplained infertility,
•        OR the infertility must be associated with one or more of the following conditions:
o        Endometriosis;
o        Fetal exposure to diethylstilbestrol, also known as DES;
o        Blocked or surgically removed fallopian tubes that are not a result of voluntary sterilization; or
o        Abnormal male factors contributing to the infertility.
The IVF benefits are subject to the same deductibles and co-insurance payments as maternity benefits. The law also permits insurers to limit coverage to a lifetime maximum of $
15,000.
(Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118).

California
The California law requires certain insurers to offer coverage for infertility diagnosis and treatment. That means group health insurers covering hospital, medical or surgical expenses
must let employers know infertility coverage is available. The law does not require those insurers to provide the coverage; nor does it force employers to include it in their employee
insurance plans.
The law defines infertility as:
•        The presence of a demonstrated condition recognized by a licensed physician and surgeon as a cause of infertility; or
•        The inability to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of sexual relations without contraception.
The law defines treatment as including, but not limited to:
•        Diagnosis and diagnostic tests;
•        Medication;
•        Surgery; and
•        Gamete Intrafallopian Transfer, also known as GIFT.
The law specifically exempts insurers from having to provide vitro fertilization coverage. Also, the law does not require employers that are religious organizations to offer coverage for
treatment that conflicts with the organization's religious and ethical purposes.
(California Health and Safety Code, Section 1374.55).

Connecticut
This law requires health insurers to mandate coverage for infertility diagnosis and treatment -- including in vitro fertilization.
The law defines infertility as the condition of a presumably healthy individual who, over the course of a year is:
• Unable to get pregnant; or
• Unable to keep or carry a pregnancy to term.
Lifetime Coverage of 4 cycles of ovulation induction, 3 cycles of intrauterine insemination and 2 cycles of in vitro fertilization, with no more than 2 embryos implanted per cycle. Must be
under 40 years to be elgible. Limits coverage to individuals who have maintained coverage under policy for at least 12 months.
(Connecticut General Statutes Annotated, Section 38a-536).

Hawaii
The Hawaii law requires certain insurance plans to provide a one-time only benefit for outpatient costs resulting from in vitro fertilization. Those plans include individual and group
health insurance plans, hospital contracts or medical service plan contracts that provide pregnancy-related benefits.
Patients need to meet the following conditions in order to get their IVF covered:
•        The patient's eggs must be fertilized with the sperm of the patient's spouse
•        The patient or the patient's spouse must have at least a five-year history of infertility;
•        The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
•        The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and
Gynecologists; and
•        The infertility must be associated with one or more of the following conditions:
o        Endometriosis;
o        Fetal exposure to diethylstilbestrol, also known as DES;
o        Blocked or surgically removed fallopian tubes; or
o        Abnormal male factors contributing to the infertility.
(Hawaii Revised Statutes, Sections 431-lOA-116.5 and 432.1-604).

Illinois
This law requires insurance policies that cover more than 25 people to cover costs of the diagnosis and treatment of infertility. The law defines infertility as the inability to get pregnant
after one year of unprotected sex or the inability to carry a pregnancy.
Coverage includes, but is not limited to:
•        In vitro fertilization (IVF); Uterine embryo lavage; Embryo transfer;
•        Artificial insemination;
•        Gamete intrafallopian transfer (GIFT);
•        Zygote intrafallopian transfer (ZIFT);
•        Intracytoplasmic Sperm Injection (ICSI);
•        Four completed egg retrievals per lifetime; and
•        Low tubal egg transfer.
Coverage for IVF, GIFT and ZIFT is required only if:
•        The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a
pregnancy;
•        The patient has not reached the maximum number of allowed egg retrievals;
•        The procedures are performed at facilities that conform to standards set by the America Society for Reproductive Medicine or the
American College of Obstetricians and Gynecologists.
The law exempts religious organizations which believe the covered procedures violate their teachings and beliefs.
(Illinois Compiled Statutes Annotated, Chapter 215, Sections 5/356m and 125/5-3).

Maryland
The Maryland law requires health and hospital insurance policies that provide pregnancy benefits to also cover the cost of in-vitro fertilization. However, the law does not apply to health
maintenance organizations, or HMOs. Policies that must provide the coverage include those covering people who live and work in the state, regardless of whether the policy is issued
in or outside the state.
Patients need to meet the following conditions in order to get their IVF covered:
•        The patient's eggs must be fertilized with the sperm of the patient's spouse;
•        The patient is unable to get pregnant through less expensive covered treatments;
•        The IVF is performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
•        The patient and his or her spouse must have at least a five-year history of infertility;
•        OR their infertility must be associated with one or more of the following conditions:
o        Endometriosis;
o        Fetal exposure to diethylstilbestrol, also known as DES; or
o        Blocked or surgically removed fallopian tubes.
Regulations that took effect in 1994 exempt businesses with 50 or fewer employers from having to provide the IVF coverage.
(Annotated Code of Maryland, Article 48A, Sections 354DD, 470W and 477EE).

Massachusetts
This state's law requires health maintenance organizations and insurers companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility
diagnosis and treatment.
The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."
Benefits covered include:
•        Artificial insemination;
•        In vitro fertilization;
•        Gamete Intrafallopian Transfer;
•        Sperm, egg and/or inseminated egg retrieval, to that extent that those costs are not covered by the donor's insurer;
•        Intracytoplasmic sperm injection

LOUISIANA

2001
Louisiana State Law
Subsection 215.23, Acts 2001, No. 1045, subsection

DEFINITION OF INFERTILITY/PATIENT REQUIREMENTS

Prohibits the exclusion of coverage for the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.

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.
Employers who self-insure are exempt from the requirements of the law.

NEW JERSEY
Group insurers and HMOs that provide pregnancy related coverage must provide infertility treatment including, but not limited to:
artificial insemination;
assisted hatching;
diagnosis and diagnostic testing;
fresh and frozen embryo transfers;
4 completed egg retrievals per lifetime;
IVF, including IVF using donor eggs and IVF where the embryo is transferred to a gestational carrier or surrogate;
ICSI;
GIFT;
ZIFT;
medications;
ovulation induction; and
surgery, including microsurgical sperm aspiration.
The procedures must be performed at facilities that conform with ACOG and ASRM guidelines.

NEW YORK
Group policies must provide diagnostic tests and procedures that include:
hysterosalpingogram;
hysteroscopy;
endometrial biopsy;
laparoscopy;
sono-hysterogram;
post coital tests;
testis biopsy;
semen analysis;
blood tests and
ultrasound
Every policy that provides for prescription drug coverage, shall also include drugs (approved by the FDA) for use in the diagnosis and treatment of infertility.

OHIO
Requires HMOs to cover “basic health care services” including infertility services, when they are medically necessary.
Diagnostic and exploratory procedures are covered, including surgical procedures to correct the medically diagnosed disease or condition of the reproductive organs including, but not
limited to:
endometriosis;
collapsed/clogged fallopian tubes;
testicular failure.
IVF, GIFT and ZIFT may be covered, but are not required by the law.

RHODE ISLAND
Insurers and HMOs that cover pregnancy benefits, must provide coverage for medically necessary expenses of diagnosis and treatment of infertility.
Coverage is provided to women between the ages of 25 and 40.
The law imposes a $100,000 cap on treatment
The insurer may impose up to a 20% co-payment.

TEXAS
Requires group insurers to offer coverage of IVF. Employers may choose whether or not to include infertility coverage as part of their employee health benefit package.
If an employer chooses to offer the benefit, patients must meet the following:
the patient for the IVF procedure is the policyholder or spouse of the policyholder;
the patient’s eggs must be fertilized with her spouse’s sperm;
the patient and the patient’s spouse have a history of infertility of at least 5 continuous years or associated with endometriosis, DES, blockage of or surgical removal of one or both
fallopian tubes or oligospermia.
the patient has been unable to attain a pregnancy through less costly treatment covered under their policy.
The IVF procedures must be performed at medical facilities that conform to ACOG and ASRM guidelines.