A Guide to Infertility Insurance

I am often asked which insurance company has the most favorable coverage for infertility treatment. Unfortunately, the answer is not that simple. The package of insurance coverage for infertility treatment is not up to the insurance company, per se. It is typically up to an employer to determine the scope of coverage that is offered by its insurance company, and whether that package includes compensation simply for diagnosis of infertility, or whether it also covers treatment.

Moreover, one cannot assume that coverage will be the same from one employer to another even if that company uses the same insurer. For instance, an employee of Bank of America with Kaiser coverage might have a completely different insurance package for infertility as compared to an employee of Wells Fargo who also has Kaiser insurance. Through negotiation, an employer may choose an insurance plan with more or less infertility coverage than the average plan.

Another caveat has to do with state regulations. A total of 12 states in the United States have passed laws mandating infertility insurance coverage. However much of this regulation is considered a "soft mandate" meaning the insurers only have to offer it to employers who can choose to take it or leave it. California (where I practice) has a soft mandate so companies here are not legally obligated to purchase coverage for its employees. A more forceful "hard mandate" requires a company to actually provide it, not just offer it. Massachusetts and Illinois are two states that have this hard mandate. An exception to this is when a company is self-insured and is not legally required to follow state mandates. Because the majority of people with employer-sponsored health insurance policies are "self-insured", the mandates do not apply to the majority of people, even in states with mandates.

Obviously, people who are self-employed and therefore pay for their own insurance might have a greater motivation to research those insurance companies that might have more comprehensive infertility coverage.

As you can tell, the nature of infertility treatment and insurance coverage is a complicated issue. We encourage patients to research infertility coverage with their insurance company and employer.

Permalink | Email Post