Health Insurance and IVF: FAQ


If you and your partner have come to the decision that fertility treatment is the way to go for your family, then you might have a set of questions regarding health insurance: whether it covers the costs of the in vitro fertilization or not. The costs of IVF can be, indeed, astronomical – one tryout costs well over $10,000. And the thing is that, usually, it takes more than one try until you actually get pregnant.

In most states in the US, the law doesn’t require health insurance plans to cover the costs of fertility treatments. Nevertheless, there are still some exceptions to the rule, such as Connecticut, New Jersey, Illinois, among others, which have decent coverage. Concurrently, even if your state doesn’t provide this, you can still discuss this problem with your employer. In other words, your employer might facilitate fertility treatment coverage as a part of the firm’s health insurance plan.

Do You Live in a State that Has an IVF Mandate?

There are nine individual states with health insurance mandates that require employers to cover the expenses of IVF treatments: Arkansas, Delaware, Connecticut, Illinois, Hawaii, Massachusetts, Rhode Island, New Jersey, and Maryland. Nevertheless, note that the type of coverage varies greatly, so make sure you have realistic expectations. There are also other seven states that have a different type of mandate. That is to say, the insurance policy might cover the costs of diagnosis tests. The states are Louisiana, California, New York, Montana, Texas, Ohio, and West Virginia.

Who Pays for Your Insurance?

For one thing, you should get acquainted with your health insurance plan and determine whether you have a fully-insured plan, you are either self-insured or part of a military or government insurance plan.

More specifically, if you are fully-insured, this means that your employer is responsible for getting the coverage, and the insurance company determines whether the costs of the IVF are covered or not. Therefore, in other words, it is the insurance company that takes on all the risk of the plan, which is why it is assessed as fully-insured.

Notwithstanding, some insurance companies might still supply IVF Riders or Infertility Riders. These are regarded as mini-benefits plans designated for IVF or other fertility treatments. You might consider asking a Human Resources representative at your firm for a quote for the IVF Rider.

Usually, self-insured plans are applicable in the case of larger companies. In this scenario, it is actually the employer that makes the decision regarding what is or isn’t covered by the plan. One of the main downsides associated with self-insured plans is that there are no state mandates that apply to them. Therefore, even if you live in one of the mandated states and your employer is self-insured, one isn’t forced to abide by the mandate law in the state.

The bottom line is that, if you are uncertain regarding the type of insurance plan you have, you should ask the HR department in your firm. After finding out this information, you can determine the steps you should follow from that point onward.

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