There are 15 states that mandate insurance cover infertility

[bam1014]

I thought this info was interesting, so I thought I would pass it on.

Not every state mandates that insurance carriers provide infertility insurance coverage to policyholders. In fact, only 15 states require this, and the types of infertility coverage each state mandates varies widely. For states that don't mandate this coverage, it's important to remember that your insurance company must still provide this coverage to you unless it's specifically excluded in your policy (so be sure to go through your policy thoroughly to make sure you're not missing out on benefits to which you are entitled). Even if infertility treatments ARE specifically excluded, there are still alternatives to getting your treatments paid for, such as appealing the exclusion or asking your employer to use an insurance carrier that provides infertility coverage.

However, if you live in one of the states where it's mandated, you're in luck, because things will be much easier for you in trying to obtain fertility treatments. In these states, as long as your employer has more than 50 employees, infertility insurance coverage MUST be provided. Here are the 15 states that require this coverage:

Arkansas

California

Connecticut

Hawaii

Illinois

Louisiana

Maryland

Massachusetts

Montana

New Jersey

New York

Ohio

Rhode Island

Texas

West Virginia

Of course, each of these states has its own particular definition of what constitutes infertility, as well as exactly how much coverage is required. In order to obtain the coverage you want, you'll need to make yourself very familiar with your policy, so you know exactly how to play your insurance company's game. Even though it will still take some self-education to use the benefits to which you're entitled, though, you're still way ahead of infertile couples in the other 35 states that don't require this coverage. Once you've learned the details of your infertility insurance coverage, you can begin to put those benefits to use and finally have the family you've longed for all these years.

So my question is, does anybody know for those of us who live in states that don't mandate it, how to petition that they do?

[tina1111]

You would need to write to your Congressman (woman). Unfortunately, even though there are 15 states that mandate it, many have sparse coverage. Most "max out" pretty quickly. Others, you must fit every category to obtain coverage. Then there are always the age & FSH restrictions. Most will not cover any infertility over a certain age or if you have ever gotten an FSH that was out of their guidelines. Even if it were only one test and another came back within range. They will still deny coverage.

I live in FL and it is a state that doesn't mandate coverage. If I asked my employer to change companies, I would get laughed out the door. I am fortunate to still work for a company that pays for the majority of my insurance. Every year the prices go up, they discuss making the employee pay for more. The fact of the matter is, to have better coverage, you pay higher premiums. I tried to get an insurance plan on my own that would cover it (when I was still young enough to qualify) and it was cheaper to pay for treatment out of pocket than the premiums.

Writing your Congressman is a place to start.

[Heather5]

Unfortunately I don;t have an answer to your questions, just wanted to add that even if you live in one of the 15 states listed above, it doesn't necessarily mean that fertility coverage is actually mandated. We had to pay EVERYTHING out of pocket, including our IVF this past spring, even though I live in one of the states listed above!

Basically, what the law in our state says is that the insurance companies HAVE TO OFFER infertility coverage...but it's up to the company you work for whether or not TO ACTUALLY INCLUDE IT in the policy they offer their employees. And since it is a lot more costly for the company to include infertility, they more often than not, choose not to.

Pretty misleading, huh?