Will new health care law cover infertility treatment?

Submitted by Shelby D Burns Sat 02/09/2013

It’s no secret that infertility treatment is expensive. The problem for insurance companies is deciding whether infertility treatments are an essential benefit helping people manage a medical disorder or is it a life-enhancing benefit, considered non-essential because it does not support a person’s life? Will new health care coverage take on infertility The new health care law is struggling to answer these questions. Members of the Institute of Medicine are currently deciding on what essential health benefits to include in policies through the state-based insurance exchanges which will be active by 2014. The IOM recommendations will go up to the Department of Health and Human Services for considerations. Most employers today do not Today, only 20% of employers maintain health insurance policies that cover infertility treatment such as in vitro fertilization. Most employers cite cost concerns as the reason they didn’t offer it, however, of the companies that do offer it, only 9% said it increased costs. And coverage can run the gamut The types of coverage vary. Some will pay for initial consultation and diagnosis, but not treatment. Others will pay for fertility drugs to stimulate ovulation or for intrauterine insemination but not for assisted reproductive technology like in vitro fertilization. Some plans do cover IVF, but only a limited number of cycles which typically cost $12,000 each. Some policies cap the dollar amount they will pay for any combination of infertility treatments. One law requires insurance companies to pay for IVF using only the spouse’s sperm – which can make things interesting for lesbian couples. Even when mandated, application is not equal There are fifteen states that mandate infertility treatments be covered. But the rules don’t apply to all businesses. Small business for example is usually exempt. Large employers might self insure and avoid these types of regulations. Try asking your employer… it might surprise you It’s too soon to know how the new policies will shape up. But if this is a concern you have, it may be interesting to know that when companies were asked why they covered infertility treatments, 65% said it was because employees asked them to. “We were shocked,” said Barbara Collura, executive director of the infertility group which conducted the Resolve survey. “They probably didn’t think it was important.”

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