Insurance coverage for the diagnosis and treatment of infertility can be arbitrary and inconsistent. Coverage varies widely from state to state and from policy to policy. To help our patients, we have a program that sorts through all of the insurance information and helps couples take advantage of any and all coverage they may have available.
In October 2005, legislation was passed in Connecticut requiring employer groups and health plans to cover medically necessary costs of diagnosing and treating infertility. In the initial law, the state only required the coverage for people under 40. However, for insurance policies sold or renewed after January 1, 2016, the age limit has been revoked. This mandate applies to health insurance plans subject to state regulation.
However, the law has many limitations and exemptions. Because of these variables, costs for infertility diagnosis and treatment for couples in Connecticut can be minimal or substantial. For more details about the Connecticut Insurance Mandate go to Public Act No. 05-196, Bulletin HC-64, Bulletin HC-104, and Bulletin JC-104, which revokes the age restriction.
As of January 2018 Connecticut passed legislation (HB 7124) to require insurance coverage of fertility preservation for insured individuals diagnosed with cancer, or whenever this treatment is medically necessary. Specifically, the new law amends the existing insurance requirement for infertility coverage in the state by changing the definition of infertility. Previously, it was defined as “the condition of a presumably healthy individual, who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period.” The new law removes the words “presumably healthy” from the definition, and extends it to include those for whom fertility services are “medically necessary.” The new definition means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. The changes apply to individual health insurance policies providing coverage delivered, issued for delivery, amended, renewed or continued on or after January 1, 2018.
The only way to determine your particular coverage is to work closely with your particular insurance carrier and examine all angles of your plan. At The Center for Advanced Reproductive Services, we have a trained staff dedicated to help. Our Insurance Program Coordinators will help couples determine what their insurance plan covers and what you can expect to spend as a result. Click here to learn more about the insurance plans in which we participate.
To find out more about our Insurance services, please contact us. Or click on the links to the left to find more about some of our specialized programs.