Does My Insurance Cover Fertility Treatments?

Fertility Care & Health Insurance

Although the cost of fertility care can be substantial, in most of the cases these costs are not covered by health insurance.

In order to check whether your health insurance policy covers your fertility treatments, you should first check your insurance policy. Insurance policies describe your benefits, covered services and your legal rights under federal law. The insurance policies also usually include information about the coverage of dependents, what services will require the employee to share the payment, the rules for pre-existing conditions, and the circumstances under which an employer can amend or terminate a health benefits plan.

Fertility Treatments Insurance Coverage Law

Fertility treatments are not covered under federal law. However, some states have infertility insurance coverage law, with various exceptions based on employer size, religious status, and type of insurance product.

The following states have infertility insurance coverage law: Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rohde Island, Texas and West Virginia. In order to be subject to the state infertility insurance coverage law, the policy must be written and/or reside in that state.

If you have “fully-insured” plan (where the employer purchases the insurance policy) which was written and/or reside in these states, your insurance follows the infertility coverage laws in the relevant state. However, “self-insured” plans (where the employer do not purchase insurance policy, but rather pay medical claims itself) are exempt from state law, and generally do not cover fertility treatments.

Each state law is different with respect to the coverage of fertility treatments. Some State laws require that health insurance companies provide coverage of fertility treatment as a benefit included in the insurance policy, and some state laws require that health insurance companies make a policy which offers coverage of fertility treatment available for purchase (i.e., the law does not require employers to pay for the fertility treatment coverage).

Sperm Banking – Insurance Coverage

Although infertility is classified as a disease, and although almost 50% of infertility cases are due to “male factor”, coverage for male fertility care is often excluded from state laws that mandate infertility coverage.

As of 2017, nine states introduced bills that would require insurance companies to provide coverage for male fertility preservation for cancer patients and/or others who are facing potential infertility as result of medical treatment. Only two states, Connecticut and Rhode Island, passed those bills into law.

Accordingly, most health insurance plans do not cover the cost of freezing & storing sperm, and in most of the cases banking your sperm would be an out-of-pocket expense.

Here at Sppare.me we understand that sperm banking might be expensive, especially when it is excluded from insurance coverage. As a mission to make fertility preservation more accessible, we offer the most affordable sperm freezing and storage packages. To learn more about the pricing of our home sperm freezing kit, click here.

Resources:
resolve
www.ncbi.nlm.nih.gov
Alliance For Fertility Preservation

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