Appendix 1: Private Insurance

Appendix 1: States That Require Private Insurance Coverage of Infertility Services
Infertility coverage required:
(As of May 2020)
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

 

Issue Brief Appendix 2: Medicaid

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