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Do you have IVF coverage and if so what state?

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Old 10-04-04, 02:43 AM
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Default Do you have IVF coverage and if so what state?

Wondering for those who have IVF coverage if you could give me a little bit more info. Which state do you live in? What kind of coverage do you have?

Thanks ladies.
 
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Old 10-04-04, 05:48 AM
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Nope, it's all out-of-pocket for me
 
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Old 10-04-04, 03:39 PM
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This is from the Serono website (manufacturer of infertility meds)

State-Mandated Insurance Coverage for Infertility Treatment

As of the publishing of this list, no federal law requires insurance coverage for infertility treatment, but fifteen states have enacted some form of infertility insurance mandate. These mandates require insurers to cover or offer to cover infertility treatment insurance in policies issued to employers. State insurance mandates do not apply to employers who self-insure.

Mandate to Cover
An insurance Mandate to Cover is a law that specifies a benefit that insurance carriers must provide. This means insurers must provide an infertility treatment benefit in every policy, and include the cost in the policy premium. Of the fifteen states with mandates, twelve have Mandates to Cover infertility treatment. See specific states for details and limitations.

Arkansas
Mandates insurance carriers to cover IVF, and allows insurers to impose a lifetime benefit cap of $15,000. Health maintenance organizations are exempt from the law.

Hawaii
Mandates insurance carriers that provide pregnancy-related benefits to cover one cycle of IVF, only after several conditions have been met.

Illinois
Mandates insurance carriers that provide pregnancy-related benefits to cover the diagnosis and treatment of infertility, including various ART procedures, but limits first-time attempts to four complete oocyte retrievals, and second births to two complete oocyte retrievals. Insurance carriers are not required to provide this benefit to businesses (group policies) of 25 or fewer employees.

Louisiana
Mandates insurance carriers to cover the "diagnosis and treatment of correctable medical conditions." Thus, insurers may not deny coverage for treatment of a correctable medical condition to someone solely because the condition results in infertility. Coverage is not required for fertility drugs; in vitro fertilization or any other assisted reproductive technique; or reversal of tubal ligation, a vasectomy, or any other method of sterilization.

Maryland
Mandates insurance carriers that provide pregnancy-related benefits to cover IVF after a two-year wait following diagnosis, with no wait required for certain diagnoses. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees. Religious organizations can choose not to provide coverage based on their religious views. A carrier may limit IVF benefits to three attempts per live birth, not to exceed a lifetime maximum benefit of $100,000.

Massachusetts
Mandates insurance carriers that provide pregnancy-related benefits to cover comprehensive infertility diagnosis and treatment, including ART procedures.

Montana
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a basic health care service. The law does not define "infertility services," and some HMOs exclude IVF.

New Jersey
Mandates insurance carriers that provide pregnancy-related benefits to cover comprehensive diagnosis and treatment of infertility, including assisted reproductive technology procedures, but limits attempts to four complete oocyte retrievals per lifetime. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees.

New York
Mandates coverage for the diagnosis and treatment of correctable medical conditions. Requires coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded, including IVF, GIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include prescription coverage must cover drugs approved by FDA for use in diagnosis and treatment of infertility (including ovulation induction). The law does not apply to HMOs.

Ohio
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a "preventative" benefit. The treatment must be "medically necessary," and the Ohio Department of Insurance has ruled that GIFT, ZIFT and IVF are not medically necessary.

Rhode Island
Requires insurers and HMOs that provide pregnancy-related benefits to cover the cost of medically necessary expenses of diagnosis and treatment of infertility. The law defines infertility as "the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year." The patient's copayment cannot exceed 20 percent.

West Virginia
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a preventative benefit. The law does not define "infertility treatment" and HMOs have interpreted the term as excluding IVF.

Mandate to Offer
An insurance Mandate to Offer is a law that requires insurers to offer coverage, which employers may or may not choose to purchase. Currently, three states have Mandates to Offer infertility treatment. Insurers in these states must offer employers a policy that provides coverage of infertility treatment, but may also offer policies that don't provide this coverage. Employers are not required to pay for infertility treatment coverage. They may choose a policy that covers infertility treatment or one that does not.

California
Mandates insurance carriers to offer group policyholders coverage of infertility treatment, excluding IVF but including GIFT. (Group health insurers covering hospital, medical or surgical expenses must let employers know infertility coverage is available.)

Connecticut
Mandates insurance carriers to offer coverage of comprehensive infertility diagnosis and treatment, including IVF procedures, to group policyholders.

Texas
Mandates insurance carriers that provide pregnancy-related benefits to offer coverage of infertility diagnosis and treatment, including IVF, to group policyholders.

For more information about any of the mandates listed here (and to determine if your state has recently changed or enacted an infertility insurance mandate), you should contact your state's Department of Health or Department of Insurance.
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Old 10-04-04, 03:50 PM
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Prior to the New York mandate going into effect, I had IVF coverage with my plan. Once infertility became mandatory they did away with the IVF rider. My assumption was that the insurance company thought they would now have to shell out a lot of money because people would be jumping at the chance of infertility coverage. I now get screwed by the loophole in the law. My employer also changed insurance plans. Since they don't cover IVF, they don't have to cover my meds. If I get an IUI (which they cover) authorized, they would cover the meds. I'm not ready to commit insurance fraud but I would understand how someone could be driven to that.

There are other procedures i.e. u/s and b/w that go along with IVF. You can have this work done for various reasons. The diagnosis doesn't necessarily have to be infertility. The insurance company may cover it then.

Good luck in your pursuit.
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Old 10-04-04, 06:34 PM
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All out of pocket for us too!
 
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