Even in today’s economy, there are ways to get more infertility and adoption benefits.
Check out your state’s law
There’s no federal mandate on infertility coverage, but 15 states have enacted legislation requiring insurance companies to cover or offer coverage for fertility treatments.
In Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia, health insurance carriers are required by law to cover the cost for infertility diagnosis and/or treatment, and some include IVF. Many of the states do not require self-funded employer plans to comply with the law. And some states have age restrictions (in New Jersey you must be under 46), marital restrictions, or other exclusions that you should review.
In California, Louisiana, and Texas, insurers are only required to offer the coverage. It’s up to employers to ask for and pay for infertility coverage in their company plan.
Remaining states have no regulation on infertility coverage. To get more details on your state’s plan go to resolve.org, and for specific questions call your state’s Insurance Commissioner’s office. Contact your state representatives to get legislation proposed in your state.
Talk to your employer
Your employer may not be aware of state law requiring fertility coverage. Even the insurance carrier doing business with your employer may not be aware of the law in your home state.
And don’t think one person can’t make a difference. Consider: Last summer a health insurance company in upstate New York was fined more than $1 million by state regulators for improperly denying infertility coverage to as many as 2,500 women. The investigation was prompted by a single complaint filed by a woman in Ithaca, New York, who was denied payment for intrauterine insemination (IUI).
Ask whoever handles medical insurance claims at your workplace if infertility is covered in any of the company’s health plans. Ask for a copy of the policies, and pay attention to covered benefits, exclusions, and restrictions. Ask your partner to do the same at his workplace. Also ask if fertility drugs are covered under a prescription drug benefit (including mail-order service, which could save you a lot).
If there are no fertility or adoption benefits where you work, build up a strong case for offering them. Go to resolve.org for more tips and a sample letter to share with management. Check out the Dave Thomas Foundation for Adoption for strategies to get adoption benefits at adoption friendlyworkplace.org.
Even in an economy when salaries are flat and employees are being asked to do more with less, many employers want to improve benefits to help keep morale up.