Insurance Coverage by State

1987
Ark. Stat. Ann
Sections 23-85-137
23-86-118

Definition of Infertility/Patient Requirements

• The patient and her spouse must have at least a 2-year history of unexplained infertility OR the infertility must be associated with at least one of the following: endometriosis; DES exposure; blocked or surgically removed fallopian tubes that are not the result of voluntary sterilization; abnormal male factors contributing to the infertility.
• The patient must be the policyholder or the spouse of the policyholder and be covered by the policy.
• The patient’s eggs must be fertilized with her spouse’s sperm.
• The patient has been unable to obtain successful pregnancy through any less costly infertility treatments covered by insurance.

Coverage

• All individual and group insurance policies that provide maternity benefits must cover in vitro fertilization (IVF). HMO’s are exempt from the law.
• Lifetime maximum of $15,000 for coverage.
• IVF procedures must be performed at a facility licensed or certified by the state and conform to the American College of Obstetricians and Gynecologists’ (ACOG) and the American Society of Reproductive Medicine (ASRM) guidelines.
• Limits preexisting condition to 12 months.
• Includes cryoperservation as an IVF procedure.
• The benefits for IVF shall be subject to the same deductibles, coinsurance and out-of-pocket limitations as under maternity benefit provisions.
• Insurers may choose to include other infertility procedures or treatments under the IVF benefit.

Exceptions

• Employers who self-insure are exempt from the requirements of the law.

1989
Cal. Health & Safety Code
Section 1374.55
Cal. Insurance Code
Section 10119.6
2019 (Fertility Preservation)
Cal. Health & Safety Code
Section 1374.551

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.

2020 Colorado Revised Statutes, 10-16-104, (23); effective 2023.

Definition of Infertility/Patient Requirements:

• Infertility means a disease or condition characterized by: (a) the failure to impregnate or conceive; (b) a person’s inability to reproduce either as an individual or with the person’s partner; or (c) a licensed physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.
• Failure to impregnate or conceive means the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a woman under the age of 35, or after 6 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a woman 35 years of age or older. Conception resulting in miscarriage does not restart the 12-month or 6-month clock to qualify as having infertility.
• Diagnosis of and treatment for infertility means the procedures and medications recommended by a licensed physician that are consistent with established, published, or approved medical practices or professional guidelines from ACOG or ASRM for diagnosing and treating infertility.
• Standard fertility preservation services means procedures and services that are consistent with medical practices or professional guidelines published by ASRM or ASCO for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

Coverage

All large group (more than 100 employees) health benefit plans issued or renewed in the state on or after January 1, 2023 shall provide coverage for the diagnosis of and treatment for infertility and standard fertility preservation services, including:

• 3 completed oocyte retrievals with unlimited embryo transfers in accordance with the guidelines of ASRM, using single embryo transfer when recommended and medically appropriate.

The health benefits plan shall not impose:

• any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications covered under the health benefit plan;
• deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations on coverage for the diagnosis of and treatment for infertility and standard fertility preservation services that are different from those imposed on benefits for services covered under the health benefit plan that are not related to infertility.

Exceptions

• Individual and small group policies are exempt unless the federal Department of Health and Human Services (HHS) determines that coverage for fertility services does not require defrayal by the state; if HHS makes such a determination, coverage for the individual and small group markets will be required 12 months after the determination.
• Does not require religious organizations to provide coverage.
• Employers who self-insure are exempt from the requirements of the law.

(For additional information on the Connecticut law, see CT Department of Insurance Bulletin)
2005, 2017

Definition of Infertility/Patient Requirements

• Infertility 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 latter refers to fertility preservation services when a medically necessary medical treatment may cause iatrogenic, or medically-induced infertility).
• 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 of 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.

2018 Del. Insurance Code
Title 18, Sections 1, § 3342 and Section 2, § 3556

Definition of Infertility/Patient Requirements

• Infertility means 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.
• 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 3 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

All individual, group and blanket health insurance policies that provide for medical or hospital expenses shall include coverage for fertility care services, including IVF and standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility. 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 of 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, copayments, 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.

1989, 2003
Hawaii Rev. Stat
Sections 431:10A-116.5
432.1-604

Definition of Infertility/Patient Requirements

• Individual and group insurers are required to cover one cycle of IVF if a patient or patient’s spouse has at least a 5 year history of infertility or the infertility is associated with at least one of the following conditions: endometriosis; DES exposure; blocked or surgically removed fallopian tubes; abnormal male factors contributing to the infertility.
• The patient’s eggs must be fertilized with her spouse’s sperm.
• Coverage is provided if the patient has been unable to obtain successful pregnancy through other infertility treatments covered by insurance.

Coverage

• One cycle of IVF.
• The coverage shall be provided to the same extent as maternity-related benefits.
• The IVF procedures must be performed at medical facilities that conform to ACOG and ASRM guidelines.

Exceptions

• Employers who self-insure are exempt from the requirements of the law.

1991, 1997, Ill Rev. Stat. ch 215
Section ILCS 5/356m
2019, Section 215 ILCS 5/356z.29 new
2022, Section 356m. Infertility coverage. (215 ILCS 5/356m) (from Ch. 73, par. 968m)

Definition of Fertility/Patient Requirements

• Infertility means a disease, condition, or status characterized by:
  (1) a failure to establish a pregnancy or to carry a pregnancy to live birth after 12 months of regular, unprotected sexual intercourse if the woman is 35 years of age or younger, or after 6 months of regular, unprotected sexual intercourse if the woman is over 35 years of age; conceiving but having a miscarriage does not restart the 12-month or 6-month term for determining infertility;
  (2) a person's inability to reproduce either as a single individual or with a partner without medical intervention; or
  (3) a licensed physician's findings based on a patient's medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.
• Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
• Standard fertility preservation services means procedures based upon current evidence-based standards of care established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other national medical associations that follow current evidence-based standards of care.

Coverage

• Group insurers and HMOs that provide pregnancy related coverage must provide infertility treatment including, but not limited to: diagnosis of infertility; IVF; uterine embryo lavage; embryo transfer; artificial insemination; GIFT; ZIFT; low tubal ovum transfer.
• Coverage for IVF, GIFT and ZIFT is provided if the patient has been unable to attain or sustain a successful pregnancy through reasonable, less costly, infertility treatments covered by insurance.
• Each patient is covered for up to 4 egg retrievals. However, if a live birth occurs, two additional egg retrievals will be covered, with a lifetime maximum of six retrievals covered.
• The procedures must be performed at facilities that conform with ACOG and ASRM guidelines.
• A policy may not impose any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services, except as provided in this Section, that are different from those imposed upon benefits for services not related to infertility.
• An individual or group policy of accident and health insurance must provide coverage for medically necessary expenses for standard fertility preservation services when a
  necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee.

Exceptions

• Employers with fewer than 25 employees do not have to provide coverage.
• Does not require religious employers to cover infertility treatment.
• Employers who self-insure are exempt from the requirements of the law.
• If HHS requires the State, pursuant to the ACA, to defray the cost of fertility preservation coverage, then fertility preservation coverage is no longer operative.

2023 Kentucky Revised Statutes

Title 25, Chapter 304, Subtitle 17A

Definition of Infertility/Patient Requirements

• "Iatrogenic infertility" is defined as an impairment of fertility caused by surgery, radiation, chemotherapy, or any other medical treatment affecting reproductive organs or processes.
• “Oocyte and sperm preservation services" means oocyte and sperm preservation procedures that are consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or any other reputable professional medical organization.
• "May directly or indirectly cause" is defined as a treatment that has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or any other reputable professional medical organization.

Coverage

• All health benefit plans will provide coverage for oocyte and sperm preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility to an insured.
• Health benefits plans include student health insurance offered by a Kentucky-licensed insurer under a written contract with a university or college whose students it proposes to insure.
• Coverage must include:
  • Evaluation expenses.
  • Laboratory assessments.
  • Medications and treatment associated with oocyte and sperm cryopreservation procedures, which includes obtaining, freezing, and storing gametes for up to one year.
• Coverage may include:
  • Exclusions for costs associated with storage of oocytes or sperm after one year.
  • Age restrictions in accordance with guidelines set forth by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
  • A lifetime limit of one oocyte or sperm cryopreservation procedure per eligible insured.
  • Limits to nonexperimental procedures, as defined by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.

• Coverage may include:
  • Exclusions for costs associated with storage of oocytes or sperm after one year.
  • Age restrictions in accordance with guidelines set forth by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
  • A lifetime limit of one oocyte or sperm cryopreservation procedure per eligible insured.
  • Limits to nonexperimental procedures, as defined by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.

Exceptions

• Employers that are religious organizations are exempt.

• Employers who are self-insured are exempt from these requirements.

2001
Louisiana State Law
Subsection 215.23, Acts 2001, No. 1045, subsection

2023
Louisiana State Law, Revised Statutes 22:1036

Definition of Infertility/Patient Requirements

• Prohibits the exclusion of coverage for the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.
• Standard fertility preservation services mean oocyte and sperm preservation procedures that are consistent with established medical practices or professional guidelines published by the American Society of Clinical Oncology or the American Society for Reproductive Medicine.
• “Iatrogenic infertility” is defined as an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment.

Coverage

• Health coverage plans must provide coverage for standard fertility preservation services for covered individuals who have been diagnosed with cancer and which necessary cancer treatment may directly or indirectly cause iatrogenic infertility.
• Coverage for standard fertility preservation services includes the costs associated with storage of oocytes and sperm, but a health coverage plan may exclude the costs of storage after three years.

Exceptions

• The law does not require insurers to cover fertility drugs, IVF or other assisted reproductive techniques, reversal of a tubal ligation, a vasectomy, or any other method of sterilization.
• Employers who self-insure are exempt from the requirements of the law.
• Religious employers may be exempt from offering fertility preservation services.

Sec. 1. 24-A MRSA §4320-S, effective January 1, 2024

Definition of Infertility/Patient Requirements

"Infertility" means the presence of a demonstrated condition recognized by a provider as a cause of loss or impairment of fertility or a couple's inability to achieve pregnancy after 12 months of unprotected intercourse when the couple has the necessary gametes for conception, including the loss of a pregnancy occurring within that 12-month period, or after a period of less than 12 months due to a person's age or other factors. Pregnancy resulting in a loss does not cause the time period of trying to achieve a pregnancy to be restarted.

"Fertility patient" means an individual or couple with infertility, an individual or couple who is at increased risk of transmitting a serious inheritable genetic or chromosomal abnormality to a child or an individual unable to conceive as an individual or with a partner because the individual or couple does not have the necessary gametes for conception.

"Fertility preservation services" means procedures, products, medications and services, intended to preserve fertility, consistent with established medical practice and professional guidelines published by the American Society for Reproductive Medicine, its successor organization or a comparable organization for an individual who has a medical or genetic condition or who is expected to undergo treatment that may directly or indirectly cause a risk of impairment of fertility.

Coverage

A carrier offering a health plan in this State shall provide coverage to an enrollee:

• For fertility diagnostic care.
• For fertility treatment if the enrollee is a fertility patient.
• For fertility preservation services.

Exceptions

• Any experimental fertility procedure; or
• Any nonmedical costs related to donor gametes, donor embryos or surrogacy.

Upon consultation with the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), the Superintendent of Insurance shall evaluate whether the coverage can be incorporated as part of the essential health benefit package or whether CMS would determine that the transfer of costs defrayed by the State to CMS would be required. The superintendent shall report by December 31, 2022 to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters concerning its consultation with CMS and the outcome of that consultation.

MARYLAND
1985, 2000
Maryland Code Article 48A, Chapter 237
MD Insurance Code Ann. Section 15-810
MD Health General Code Ann. Section 19-701
2015-16 MD Insurance Code Ann. Section 15-810
2018 (Fertility Preservation)
Maryland Code Article 48A, Chapter 715
MD Insurance Code Ann. Section 15-801.1; Section 31-116(a)
2020
MD Insurance Code Ann. Section 15-810

Definition of Infertility/Patient Requirements

• For a married patient, the patient and the patient’s spouse have a history of involuntary infertility, demonstrated by a history of:
  • if the patient and the patient’s spouse are of opposite sexes, intercourse of at least 1 year’s duration failing to result in pregnancy; or
  • if the patient and the patient’s spouse are of the same sex, three attempts of artificial insemination over the course of 1 year failing to result in pregnancy; or
  • the infertility of the patient or patient’s spouse is associated with any of the following: endometriosis; DES exposure; blocked or surgically removed fallopian tubes; abnormal male factors contributing to the infertility

• For an unmarried patient,
  • the patient has had three attempts of artificial insemination over the course of 1 year failing to result in pregnancy; or
  •  the infertility is associated with any of the following: endometriosis; DES exposure; blocked or surgically removed fallopian tubes; abnormal male factors contributing to the infertility.
• The patient is the policyholder or a covered dependent of the policyholder.
• The patient has been unable to obtain successful pregnancy through any less costly infertility treatments covered by insurance.
• Iatrogenic infertility means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.
• Medical treatment that may directly or indirectly cause iatrogenic infertility means medical treatment with a likely side effect of infertility as established by the American Society for Reproductive Medicine (ASRM), American College of Obstetricians and Gynecologists (ACOG), or the American Society of Clinical Oncology (ASCO)

Coverage

• Individual and group insurance policies that provide pregnancy-related benefits must cover the cost of 3 IVFs per live birth.
•  Lifetime maximum of $100,000.
• IVF procedures must be performed at clinics that conform to ASRM and ACOG Guidelines.

Exceptions

• Does not require religious employers to cover infertility treatment or fertility preservation procedures.
• Employers with fewer than 50 employees do not have to provide coverage.
• Employers who self-insure are exempt from the requirements of the law.
• Does not include the storage of sperm or oocytes.

1987, amended 2010
Mass Gen Laws Ann. Ch. 175, Section 47H, ch. 176A, Section 8K, ch.176B, Section 4J, ch 176G, Section 4, and 211 CMR 37.00

Definition of Infertility/Patient Requirements

• Infertility means the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35. For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1-year or 6-month period.

Coverage

• All insurers providing pregnancy-related benefits shall provide for the diagnosis and treatment of infertility including the following: artificial insemination; IVF; GIFT; sperm, egg and/or inseminated egg procurement and processing, and banking of sperm or inseminated eggs, to the extent such costs are not covered by the donor’s insurer, if any; ICSI; ZIFT; assisted hatching; cryopreservation of eggs.
• Conceiving but having a miscarriage does not restart the 1-year or 6-month clock to qualify as having infertility.
• Insurers shall not impose any exclusions, limitations or other restrictions on coverage of infertility drugs that are different from those imposed on any other prescription drugs, nor shall they impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage for required infertility benefits which are different from those imposed upon benefits for services not related to infertility.
• The law does not limit the number of treatment cycles and does not have a dollar lifetime cap. Insurers may set limits based on their clinical guidelines and patients’ medical histories.

Exceptions

• Insurers are not required to cover (but are not prohibited from covering) experimental infertility procedures, surrogacy, or reversal of voluntary sterilization.
• Employers who self-insure are exempt from the requirements of the law.

1987
Mont. Code Ann. Section 33-22-1521
Section 33-31-102(2)(v)

2023
Mont. Code Ann. 2-18-704
Title 33, chapter 22

Definition of Infertility/Patient Requirements

• Infertility is not defined in the law or regulation.
• "Iatrogenic infertility" is defined as an impairment of fertility caused by surgery, radiation, chemotherapy, or any other medical treatment affecting reproductive organs or processes.
• All health benefit plans will provide coverage for oocyte and sperm preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility to an insured.
  • “Oocyte and sperm preservation services" means oocyte and sperm preservation procedures that are consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or any other reputable professional medical organization.
  • "May directly or indirectly cause" is defined as a treatment that has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or any other reputable professional medical organization.

Coverage

Requires HMOs to cover infertility services as part of basic health care services.

Starting January 1, 2024, each individual and group disability policy, certificate of insurance, and membership contract that provides coverage for hospital, medical, or surgical services must cover medically necessary costs for standard fertility preservation services when an insured member is diagnosed with cancer and the standard of care involves medical treatment that may directly or indirectly cause iatrogenic infertility.

Medical assistance provided by the Montana Medicaid program also includes fertility preservation services.

• This coverage will include:
  • Evaluation expenses.
  • Laboratory assessments.
  • Medications and treatment associated with oocyte and sperm cryopreservation procedures, which includes obtaining, freezing, and storing gametes for up to one year.
• This Coverage may include:
  • Exclusions for costs associated with storage of oocytes or sperm after one year.
  • Age restrictions in accordance with guidelines set forth by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.
  • A lifetime limit of one oocyte or sperm cryopreservation procedure per eligible insured.
  • Limits to nonexperimental procedures, as defined by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.

Exceptions

• Employers who self-insure are exempt from the requirements of the law.
• Employers that are religious organizations are exempt.
• Disability income, hospital indemnity, accident-only, vision, dental, or long-term care policies are exempt from the fertility preservation mandate.

2020 NH RSA CHAPTER 417-G

Definition of Infertility/Patient Requirements

Infertility means a disease, caused by an illness, injury, underlying disease, or condition, where an individual’s ability to become pregnant or to carry a pregnancy to live birth is impaired, or where an individual’s ability to cause pregnancy and live birth in the individual’s partner is impaired.

Standard fertility preservation services means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology.

Coverage

Each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the following:

• Diagnosis of the cause of infertility.
• Medically necessary fertility treatment. This includes coverage for evaluations, laboratory assessments, medications, and treatments associated with the procurement of donor eggs, sperm, and embryos.
• Fertility preservation when a person is expected to undergo surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment of fertility. This includes coverage for standard fertility preservation services, including the procurement and cryopreservation of embryos, eggs, sperm, and reproductive material determined not to be an experimental infertility procedure. Storage shall be covered from the time of cryopreservation for the duration of the policy term. Storage offered for a longer period of time, as approved by the health carrier, shall be an optional benefit.

No health insurance carrier may:

• Impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage which are different from those imposed upon benefits for services not related to infertility or any limitations on coverage of fertility medications that are different from those imposed on any other prescription medications.
• Impose pre-existing condition exclusions or pre-existing condition waiting periods on coverage for required benefits or use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting or otherwise restricting the availability of coverage for required benefits.
• Impose limitations on coverage based solely on arbitrary factors including, but not limited to, number of attempts or dollar amounts or age, or provide different benefits to, or impose different requirements upon, a class protected under RSA 354-A than that provided to, or required of, other patients.

Limitations on coverage shall be based on clinical guidelines and the enrollee’s medical history. Clinical guidelines shall be maintained in written form and shall be available to any enrollee upon request. Standards or guidelines developed by the American Society for Reproductive Medicine, the American College of Obstetrics and Gynecology, or the Society for Assisted Reproductive Technology may serve as a basis for these clinical guidelines.

Exceptions

Coverage does not apply to plans available through the Small Business Health Options Program (SHOP) or to Extended Transition to Affordable Care Act-Compliant Policies.

Does not cover experimental infertility procedures, non-medical costs related to third party reproduction, or reversal of voluntary sterilization. Where an enrollee is utilizing a surrogate or gestational carrier due to a medical cause of infertility unrelated to voluntary sterilization or failed reversal, the enrollee’s coverage shall not extend to medical costs relating to the preparation for reception or introduction of embryos, oocytes, or donor sperm into a surrogate or gestational carrier.

2001, 2017, 2019
NJ Laws, Chap. 236 and supplementing Title 52 of the Revised Statutes

Definition of Infertility/Patient Requirements

• 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 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:
  1. A male is unable to impregnate a female;
  2. A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
  3. A female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;
  4. 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;
  5. 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;
  6. Partners are unable to conceive as a result of involuntary medical sterility;
  7. A person is unable to carry a pregnancy to live birth; or
  8. A previous determination of infertility pursuant to this section.

• Infertility resulting from voluntary sterilization procedures are excluded from coverage.
• 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.
• “Iatrogenic infertility” means an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
• “Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health.

COVERAGE

Group insurers, HMOs, State Health Benefits Program, and School Employees Health Benefits Program that provide pregnancy related coverage must provide infertility treatment including, but not limited to:

• artificial insemination;
• assisted hatching;
• diagnosis and diagnostic testing;
• fresh and frozen embryo transfers;
• 4 completed egg retrievals per lifetime;
• IVF, including IVF using donor eggs and IVF where the embryo is transferred to a gestational carrier or surrogate;
• ICSI;
• GIFT;
• ZIFT;
• medications;
• ovulation induction; and
• surgery, including microsurgical sperm aspiration; and
• standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
• 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.
• Cryoperservation is not covered except for those at risk of iatrogenic infertility.
• Nonmedical costs of egg or sperm donor are not covered.
• Infertility treatments that are experimental or investigational are not covered.
• Does not include the storage of sperm or oocytes.
• Does not require religious employers to cover infertility treatment.
• Employers who self-insure are exempt from the requirements of the law.

1990, 2002, 2020
NY S.B. 6257-B/A.B. 9759-B
NY Insurance Law Sections 3216 (13), 3221
FY 2020 New York State Budget

Definition of Infertility/Patient Requirements

• 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 twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five 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

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 and
• ultrasound
• Provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to patients in the large group insurance market (100 or more employees).
• 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 for prescription drug coverage, shall 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.

Exceptions

• Excludes coverage for IVF in the individual and small group markets, GIFT, and ZIFT; reversal of elective sterilizations; sex change procedures; cloning or experimental medical or surgical procedures.
• Employers who self-insure are exempt from the requirements of the law.

1991
Ohio Rev. Code Ann. Section 1751.01(A)(7)

Coverage

• Requires HMOs to cover “basic health care services” including infertility services, when they are medically necessary.
• Diagnostic and exploratory procedures are covered, including surgical procedures to correct the medically diagnosed disease or condition of the reproductive organs including, but not limited to: endometriosis; collapsed/clogged fallopian tubes; testicular failure.
• IVF, GIFT and ZIFT may be covered, but are not required by the law.

Exceptions

• Employers who self-insure are exempt from the requirements of the law.

1989
RI Gen. Laws sections 27-18-30, 27-19-23, 27-20-20, and 27-41-33
Revised 2006 and 2017

Definition of Infertility/Patient Requirements

• Infertility means the condition of an otherwise presumably healthy individual who is unable to conceive or produce conception during a period of one year. Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.

Coverage

• Insurers and HMOs that cover pregnancy benefits, must provide coverage for medically necessary expenses of diagnosis and treatment of infertility and for standard fertility preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
• Coverage is provided to women between the ages of 25 and 42 for diagnosis and treatment of infertility (does not apply to fertility preservation).
• The law imposes a $100,000 cap on treatment.
• The insurer may impose up to a 20% co-payment.

Exceptions

• Employers who self-insure are exempt from the requirements of the law.

1987
Tex. Insurance Code Ann. Section 3.51-6, Sec. 3A

2023
Tex. Health and Safety Code. Section 1, Chapter 161

Definition of Infertilty/Patient Requirements

• Requires group insurers to offer coverage of IVF. Employers may choose whether or not to include infertility coverage as part of their employee health benefit package.
• If an employer chooses to offer the benefit, patients must meet the following: the patient for the IVF procedure is the policyholder or spouse of the policyholder; the patient’s eggs must be fertilized with her spouse’s sperm; the patient and the patient’s spouse have a history of infertility of at least five continuous years or associated with endometriosis, DES, blockage of or surgical removal of one or both fallopian tubes or oligospermia; the patient has been unable to attain a pregnancy through less costly treatment covered under their policy; the IVF procedures must be performed at medical facilities that conform to ACOG and ASRM guidelines.
• Standard fertility preservation services mean (1) the collection and preservation of sperm, unfertilized oocytes, and ovarian tissue; and (2) does not include the storage of such unfertilized genetic materials.

Coverage

• No coverage is required. Insurers are only required to offer IVF.
• A health benefit plan must provide coverage for fertility preservation services to a covered person who will receive a medically necessary treatment for cancer, including surgery, chemotherapy, or radiation, that the American Society of Clinical Oncology or the American Society for Reproductive Medicine has established may directly or indirectly cause impaired fertility.

Exceptions

• Does not require religious employers to cover infertility treatment.
• Employers who self-insure are exempt from the requirements of the law.
• Medicaid managed care programs are exempt from covering fertility preservation services.

Amends 49-20-418, as enacted by Laws of Utah 2018, Chapter 357; 63I-1-249, as last amended by Laws of Utah 2020, Chapter 98
Enacts 26-18-420.1, Utah Code Annotated 1953; 76-07-401, Utah Code Annotated 1953; 76-07-402, Utah Code Annotated 1953

Definition of Infertility/Patient Requirements

For 3-year pilot program for Public Employees’ Health Plan, 2018-2021; extended 2021-2024:

• The patient’s physician verifies that the patient or the patient’s spouse has a demonstrated condition recognized by a physician as a cause of infertility; or
• The patient attests that the patient is unable to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations without contraception.
• The patient attests that the patient has been unable to attain a successful pregnancy through any less-costly, potentially effective infertility treatments for which coverage is available under the health benefit plan.

For Medicaid patients (if waiver is approved), effective January 1, 2023:

• Patient has been diagnosed with a form of cancer by a physician; and needs treatment for that cancer that may cause a substantial risk of sterility or iatrogenic infertility, including surgery, radiation, or chemotherapy.
• "Iatrogenic infertility" means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment.

Coverage

For 3-year pilot program for Public Employees’ Health Plan, 2018-2021; extended 2021-2024:

• If policy offers optional maternity benefits, then it must also offer an indemnity benefit of $4,000 to obtain infertility treatments.

For Medicaid patients (if waiver is approved), effective January 1, 2023:

• "Standard fertility preservation service" means a fertility preservation procedure and service that:
  • is not considered experimental or investigational by the American Society for Reproductive Medicine or the American Society of Clinical Oncology; and
  • is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology, including:
    • sperm banking;
    • oocyte banking;
    • embryo banking;
    • banking of reproductive tissues; and
    • storage of reproductive cells and tissues.

2023 Council of the District of Columbia

70 D.C. Reg. 010351 (July 28, 2023)

Definition of Infertility/Patient Requirements

• Requires individual or group health benefit plans to provide coverage for the diagnosis and treatment of infertility and standard fertility preservation services and requires health insurers offering health insurance coverage through Medicaid and the DC Healthcare Alliance program to cover the diagnosis and medication treatment of infertility.
• “Infertility” means a disease, condition, or status characterized by the failure to establish a pregnancy or to carry a pregnancy to live birth after regular unprotected sexual intercourse in accordance with the guidelines of ASRM, a person’s inability to reproduce without medical intervention either as a single individual or with their partner, or a licensed physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.
• “Treatment for infertility” means procedures consistent with established medical practices in the treatment of infertility by licensed physicians and surgeons, including diagnosis, diagnostic tests, medication, surgery, or gamete intrafallopian transfer.
• “Standard fertility preservation services” means procedures that are consistent with established medical practices or professional guidelines published by ASRM or the American Society of Clinical Oncology for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

Coverage

• Beginning January 1, 2025, all health insurers offering an individual, small group, or large group health benefit plan must provide coverage for the diagnosis and treatment of infertility, including the following:
  • Three rounds of IVF
  • Standard fertility preservation services.
  • At least 3 complete oocyte retrievals with unlimited embryo transfers from those oocyte retrievals or from any oocyte retrieval performed prior to January 1, 2025.
  • The medical costs related to an embryo transfer to be made from an enrollee to a third-party; except, that the enrollee’s coverage shall not extend to any medical costs of the surrogate or gestational carrier after the embryo transfer procedure.

• Beginning January 1, 2024, the DC Healthcare Alliance program shall provide health insurance coverage for the diagnosis of infertility and any medically necessary ovulation enhancing drugs and medical services related to prescribing and monitoring the use of such drugs, which shall include at least 3 cycles of ovulation-enhancing medication treatment over an enrollee’s lifetime.
• By January 1, 2024, the Department of Health Care Finance will submit an amendment to the Medicaid state plan to the Centers for Medicare & Medicaid Services (CMS) that would authorize coverage through Medicaid for the diagnosis of infertility and any medically necessary ovulation enhancing drugs and medical services related to prescribing and monitoring the use of such drugs, which will include at least 3 cycles of ovulation-enhancing medication treatment over an enrollee’s lifetime.
• Within 180 days of the effective date of this section, the Department of Health Care Finance shall submit a report to the Council after consulting with CMS on whether in vitro fertilization and standard fertility preservation services are medically reasonable and necessary procedures under federal law, possible methods for covering in-vitro fertilization and standard fertility preservation services as a Medicaid covered benefit for both fee-for-service and managed care organizations, including any potentially applicable waiver authorities, and the amount of money that would need to be allocated to federal and local funds for such coverage.
• Coverage for the treatment of infertility shall be provided without discrimination on the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation.

A health insurer shall not impose:

• Deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage for the diagnosis and treatment of infertility, including the prescription of fertility medications, different from those imposed upon benefits for services not related to infertility; (
• Pre-existing condition exclusions or pre-existing condition waiting periods on coverage for the diagnosis and treatment of infertility or use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting, or otherwise restricting the availability of coverage for required benefits; or
• Limitations on coverage based solely on arbitrary factors, including number of attempts, dollar amounts, or age, or provide different benefits to, or impose different requirements upon, a class protected under the Human Rights Act of 1977, than that provided to other patients.
• Nothing in this section shall be construed to interfere with the clinical judgment of a physician or surgeon.

Exceptions

• Employers who are self-insured are exempt from these requirements.

1995
W.Va. Code Section 33-25A-2

Definition of Infertility/Patient Requirements

• The law does not define “infertility.”

Coverage

• Requires HMOs to cover infertility services under “basic health care services.”

Exception

• Employers who self-insure are exempt from the requirements of the law.