Every state in America has some regulations for insurance for people who need fertility treatment or fertility preservations for any medical reason.
Questions to Ask Your Insurance Company
Before starting any fertility treatment program, patients should obtain written answers to the following questions:
- Does my policy cover infertility diagnosis and treatment?
- Is IVF covered, or is coverage limited to testing and medication?
- Are there age, diagnosis, or medical-necessity requirements?
- Are there limits on treatment cycles or lifetime benefits?
- Are fertility medications covered under the medical or pharmacy benefit?
- Are donor eggs, donor sperm, or donor embryos covered?
- Are egg freezing and embryo storage covered?
- Are genetic testing and frozen embryo transfer covered?
- Do I need to use a designated fertility center or specialty pharmacy?
- What happens financially if a cycle is cancelled or no embryo is available for transfer?
Patients covered by self-funded employer plans should also understand that federal ERISA rules may affect which state insurance requirements apply. The actual plan documents are essential.