State Fertility Insurance Laws
Currently, 20 states have passed laws that require health insurance coverage for an infertility diagnosis and/or fertility treatment, and seven states have fertility preservation laws for iatrogenic (medically-induced) infertility.
If you live or work in a state that has a mandate to cover infertility care, we recommend you explore your employer plan further by asking the following questions.
- Is my employer plan fully insured or self insured?
Fully insured plans follow state law. Self-insured plans follow federal law and are exempt from state law. - Is my employer plan a “greater than 25” plan, “greater than 50” plan, etc?If yes, employers with fewer than a set number of employees do not have to provide coverage.
- Is my employer plan written in the governed state?Generally, the policy must be written and/or reside in the state that has an infertility coverage law.
- Did you answer “yes” to more than one?
If so, we recommend you research which are fully insured plans in the state with an infertility coverage law.
Accepted Insurance
90% of patients have coverage for an initial consult and 70% have some coverage for testing and treatment.
Understand Your State’s Fertility Mandate
Definition of Infertility/Patient Requirements:
- Requires group insurers to offer coverage of infertility treatment, except IVF. Employers may choose whether or not to include infertility coverage as part of their employee health benefit package.
- Infertility means the presence of a demonstrated condition recognized by a physicians 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 regular sexual relations without contraception.
- “Iatrogenic infertility” means infertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.
- “Standard fertility preservation services” means procedures consistent with the established medical practices and professional guidelines published by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.
Coverage:
- No infertility treatment coverage is required. Insurers are only required to offer the following services to employers who decide if they will provide the following benefits to their employees: diagnosis, diagnostic testing, medication, surgery, and Gamete Intrafallopian Transfer (GIFT).
- When a covered treatment may cause iatrogenic infertility to an enrollee, standard fertility preservation services are a basic health care service; these provisions are declaratory of existing law that requires every health care service plan contract to provide enrollees with basic health care services.
Exceptions:
- Only requires insurers to offer infertility treatment coverage.
- Does not include IVF.
- Does not require religious organizations to offer coverage.
- Fertility preservation coverage does not apply to Medi-Cal managed care health care service plan contracts.
- Employers who self-insure are exempt from the requirements of the law.
The Colorado Building Families Act, which took effect January 1, 2023, will require large group insurance plans issued or renewed in Colorado to cover the diagnosis of infertility, treatment for infertility, and fertility preservation services.
The law defines infertility as:
The Colorado Building Families Act provides coverage for medically necessary fertility preservation treatments. Which means infertility caused by medical intervention such as radiation, medication, or surgery. This means freezing sperm, eggs or embryos before those medical procedures. Again, this coverage is required in commercial insurance plans in the large group market only.
The law also features a definition of infertility that is inclusive of the LGBTQ+ community and unpartnered individuals.
Coverage:
- This new law provides coverage for three completed egg retrievals and unlimited embryo transfers.
Exceptions:
- Employers who self-insure are exempt from the requirements of the law.
The Connecticut Law states medically necessary expenses of the diagnosis and treatment of infertility must be covered by health insurance companies.
The law defines infertility as:
Infertility means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a 1-year period or such treatment is medically necessary (the latter refers to fertility preservation services when a medically necessary medical treatment may cause iatrogenic, or medically-induced infertility).
Patient criteria:
Limits coverage to individuals who have maintained coverage under a policy for at least 12 months.
Coverage:
- Lifetime maximum coverage of 4 cycles of ovulation induction.
- Lifetime maximum coverage of 3 cycles of intrauterine insemination.
- Lifetime maximum coverage of 2 cycles of IVF, GIFT, ZIFT or low tubal ovum transfer, with not more than 2 embryo implantations per cycle. Each fertilization or transfer is credited as one cycle towards the maximum.
- Limits coverage for IVF, GIFT, ZIFT and low tubal ovum transfer to individuals who have been unable to conceive or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures, unless the individual’s physician determines that those treatments are likely to be unsuccessful.
- Requires infertility treatment or procedures to be performed at facilities that conform to the American Society for Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
Exceptions:
- Does not require religious organizations to offer coverage.
- Employers who self-insure are exempt from the requirements of the law.
The 2018 Delaware Insurance Code Title 18, Sections 1, § 3342 and Section 2, § 3556 requires all individual, group and blanket health insurance policies that cover more than 50 people and provide for medical or hospital expenses must include coverage for fertility care services. This coverage includes in vitro fertilization (IVF) and standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility.
There is a limit to six completed egg retrievals per lifetime, with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine, using single embryo transfer (“SET”) when recommended and medically appropriate.
The law defines infertility as:
A disease or condition that results in impaired function of the reproductive system whereby an individual is unable to procreate or to carry a pregnancy to live birth. Iatrogenic infertility means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
Patient criteria:
- Such benefits must be provided to covered individuals, including covered spouses and covered non-spouse dependents, to the same extent as other pregnancy-related benefits.
- Covered individual has not been able to obtain a successful pregnancy through reasonable effort with less costly infertility treatments covered by the policy, contract, or certificate, except as follows:
- No more than three treatment cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered.
- If IVF is medically necessary, no cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered.
- For IVF services, retrievals are completed before the individual is 45 years old and transfers are completed before the individual is 50 years old.
Coverage:
Such benefits must be provided to the same extent as other pregnancy-related benefits and include the following:
- Intrauterine insemination
- Assisted hatching
- Cryopreservation and thawing of eggs, sperm, and embryos
- Cryopreservation of ovarian tissue
- Cryopreservation of testicular tissue
- Embryo biopsy
- Consultation and diagnostic testing
- Fresh and frozen embryo transfers
- Six completed egg retrievals per lifetime, with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine, using single embryo transfer (“SET”) when recommended and medically appropriate.
- IVF, including IVF using donor eggs, sperm, or embryos, and IVF where the embryo is transferred to a gestational carrier or surrogate
- Intra-cytoplasmic sperm injection (ICSI)
- Medications
- Ovulation induction
- Storage of oocytes, sperm, embryos, and tissue
- Surgery, including microsurgical sperm aspiration
- Medical and laboratory services that reduce excess embryo creation through egg cryopreservation and thawing in accordance with an individual’s religious or ethical beliefs
- Requires infertility treatment or procedures to be performed at facilities that conform to the American Society for Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines
- A policy may not impose restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose deductibles, co-payments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for required fertility care services, which are different from those imposed upon benefits for services not related to infertility.
Exceptions:
- Experimental fertility care services, monetary payments to gestational carriers or surrogates, or the reversal of voluntary sterilization undergone after the covered individual successfully procreated with the covered individual’s partner are not covered.
- Does not require religious organizations to provide coverage.
- Employers who self-insure or who have fewer than 50 employees are exempt from the requirements of the law.
The Maryland Insurance Article Section 15-810, “Benefits for In Vitro Fertilization,” requires health and hospital insurance policies issued within the state that provide pregnancy benefits to also cover the cost of in vitro fertilization (IVF). Effective January 1, 2021, Maryland’s Mandated Benefits no longer has a marriage requirement for patients to receive benefits for IVF treatment. There is a limit of three IVF attempts per live birth; not to exceed a maximum lifetime benefit of $100,000.
Patient criteria:
For contracts that follow the Maryland mandate, benefits are provided when all of the following criteria are met:
- The patient must be a policyholder or subscriber, or a covered spouse of the policyholder or subscriber.
- The patient is unable to get pregnant through less-expensive covered treatments.
- For patients whose spouse is of the opposite sex, the patient and her spouse must have at least a 1-year history of involuntary infertility or infertility must be associated with one or more of the following conditions
- Endometriosis
- Fetal exposure to diethylstilbestrol, also known as DES
- Blocked or surgically removed Fallopian tubes
- Abnormal male factors, including oligospermia, contributing to the infertility
- For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm.
- For patients whose spouse is of the same sex, there must be three attempts of artificial insemination over the course of 1 year failing to result in pregnancy.
- IVF must be performed at a facility that conforms to the standards set by the American Fertility Society and the American Congress of Obstetricians and Gynecologists.
Exemptions:
- Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide IVF coverage. [Code of Maryland Regulations (COMAR) 31.11.06.06 (B) (11).]
- Religious organizations offering health benefits to their employees may request that carriers exclude IVF benefits; there must be bona fide religious beliefs and practices that prohibit IVF.
The New Jersey Laws, Chap. 236 and supplementing Title 52 of the Revised Statutes requires all group insurers, HMOs, State Benefits Program, and School Employees Health Benefits Program that cover more than 50 people and provide pregnancy-related coverage, must also provide coverage for infertility diagnosis and treatment.
The law defines infertility as:
Infertility means a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine (ASRM) practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or any one of the following conditions:
- A male is unable to impregnate a female;
- A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
- A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;
- A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;
- A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;
- Partners are unable to conceive as a result of involuntary medical sterility;
- A person is unable to carry a pregnancy to live birth; or
- A previous determination of infertility pursuant to this section.
Patient criteria:
- Must be less than 46 years of age.
- The patient has been unable to obtain successful pregnancy through any less costly infertility treatments covered by insurance.
- Infertility resulting from voluntary sterilization procedures are excluded from coverage.
Coverage:
Includes, but is not limited to:
- Artificial insemination
- Assisted hatching
- Diagnosis and diagnostic testing
- Fresh and frozen embryo transfers
- Four completed egg retrievals per lifetime
- IVF, including IVF using donor eggs and IVF where the embryo is transferred to a gestational carrier or surrogate
- Intracytoplasmic sperm injection (ICSI)
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
- Medications
- Ovulation induction
- Surgery, including microsurgical sperm aspiration
- The procedures must be performed at facilities that conform with ACOG and ASRM guidelines.
Exceptions:
- Employers with fewer than 50 employees do not have to provide coverage.
- Cryopreservation is not covered.
- Nonmedical costs of egg or sperm donor are not covered.
- Infertility treatments that are experimental or investigational are not covered.
- Does not require religious employers to cover infertility treatment.
- Employers who self-insure are exempt from the requirements of the law.
The New York Insurance Law Sections 3216 (13), 3221, requires all employers within large group health insurance markets (100 employees or more), issued or delivered within the state of New York providing coverage for hospital care or surgical and medical care, to provide coverage for the diagnosis and treatment of infertility. There is a limit of three cycles of in vitro fertilization (IVF) for people who have been diagnosed with infertility.
The law defines infertility as:
Infertility means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after 6 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.
Patient criteria:
- The patient must be between the ages of 21 and 44, and covered under the policy for at least 12 months.
- Prohibits the exclusion of coverage for the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.
- Infertility means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after 6 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.
- Standard fertility preservation procedures are covered but not defined by law.
Coverage:
- Provides up to three in vitro fertilization (IVF) cycles (fresh embryo transfer or frozen embryo transfer) to patients in the large group insurance market (100 or more employees) who have been diagnosed with infertility.
- Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets (individual, small and large groups).
- Every policy that provides coverage for prescription drugs will also include drugs (approved by the FDA) for use in the diagnosis and treatment of infertility.
- Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.
- 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
- Ultrasound
Exceptions:
- Excludes GIFT, and ZIFT; reversal of elective sterilizations; sex change procedures; cloning or experimental medical or surgical procedures.
- Excludes coverage for IVF in the individual and small group markets.
- Employers who self-insure are exempt from the requirements of the law.
The West Virginia Code Section 33-25A-2 requires HMOs to cover basic health care services, including infertility services, when medically necessary.
Exemptions:
- Employers who self-insure are exempt from the requirement of the law.
