Health Insurance and Paying for Infertility Diagnosis

Armen Hareyan's picture

Are health insurance companies required to pay for infertility diagnosis and treatment?

Infertility coverage is a hotly debated topic among health insurance companies, consumer rights advocates, employers, pharmaceutical companies, religious groups, and many others. Presently, there isn't one right answer to this question.


More than a dozen states have passed some sort of legislation regarding infertility coverage. Some of these states require that health insurance plans provide some level of infertility coverage. Other states require policyholders to offer some coverage for infertility, but give the applicants the option of refusing the coverage. The remaining states have no regulations mandating coverage for infertility diagnosis or treatment.

In states that mandate coverage, the level of required coverage varies. Some states allow insurers to impose a lifetime benefit cap, some limit the length of required coverage, and some permit them to require a co-payment.

Not every health plan is subject to state regulation. Individual and employer-sponsored health insurance plans bought through insurance companies are subject to state regulation. However, health insurance plans sponsored by employers who self-insure are not. Certain other types of health coverage, such as those purchased by churches and other nonprofit groups, are also not subject to state regulation. Health plans not subject to state regulation may voluntarily provide infertility benefits, but you will have to check with your health insurance company to find out.

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