The Difference Between State Mandates to Cover and to Offer Infertility Insurance Coverage

Out of the 15 states that have mandated coverage- Connecticut - Self-insurers and religious organizations
of infertility in health insurance policies, only Californiaexempt; all individual and group policies must cover
and Texas have mandates to offer coverage in- Hawaii - Self-insurers exempt; all individual and group
health care policies. What this means to a couplepolicies must cover
dealing with infertility is that their employer has the- Illinois - Self-insurers, religious employers, and
option to purchase health insurance that offers somecompanies with fewer than 25 employees exempt; all
coverage for infertility testing, diagnosis andgroup and HMOs that cover pregnancy must cover
treatment, but they are not required to buy such- Louisiana - Self-insurers exempt; cannot exclude
insurance.coverage just because condition results in infertility
There are many factors that go into the choice of- Maryland - Self-insurers, religious employers, and
which insurance policy or policies to purchase andcompanies with fewer than 50 employees exempt; all
offer to employees, price being one of them. If youindividual and group policies that cover pregnancy
live in California or Texas and your employer's choicemust cover
of insurance coverage does not include any infertility- Massachusetts - Self-insurers exempt; all insurers
coverage, you should talk to your human resourcesthat cover pregnancy must cover
manager or the manager of benefits and find out if it- Montana - Self-insurers exempt; HMOs required to
would be possible to have the company offercover as basic health care
additional health insurance policy options with at least- New Jersey - Self-insurers, religious employers, and
one of them offering infertility coverage.companies with fewer than 50 employees exempt;
The company may not want to offer such insurancegroup insurers and HMOs that cover pregnancy must
if their costs will be going up, especially if they believecover
that only one or two employees want such- New York - Self-insurers exempt; group policies
coverage. So go a little grass roots and find out ifmust cover testing and diagnosis
your co-workers would be willing to pay more for- Ohio - Self-insurers exempt; HMOs required to
such coverage, and ask them all to ask for it as ancover as basic health care
option in future insurance offerings. You may be- Rhode Island - Self-insurers exempt; individual and
surprised at how many co-workers would like suchgroup policies and HMOs that cover pregnancy must
coverage and your company may surprise you andcover
offer additional choices in insurance coverage in the- West Virginia - Self-insurers exempt; HMOs required
future.to cover as basic health care
That leaves us with 13 states, listed just below alongA state mandate to cover means that unless a
with some information, that have mandates to cover.business's group, and in some cases individual, health
Depending on the wording of the law for each state,care insurance is exempt, some form of infertility
health insurance policies and/or HMOs that offercoverage must be included in the policy. On the flip
anything from basic coverage to maternity coverage,side of the issue is the state mandate to offer,
must also cover some infertility testing, diagnosis andwhich only means that the insurance company has to
treatments. Basically, a mandate to cover is just that,offer for sale a policy that includes infertility
they must cover "something" where infertility iscoverage, but the business is not required to
concerned and many of the state laws statepurchase that coverage. Knowing not only what your
specifically what must be covered too.insurance policy states is covered, but also what your
- Arkansas - HMOs and self-insurers exempt; allstate's mandate is, can help you when navigating the
individual and group policies that cover maternityworld of infertility and insurance coverage.
must cover