The desire to start a family does not discriminate by state. People all over the U.S. can require help in their family planning journey. But healthcare in the U.S. is most often dependent on employer-provided medical insurance policies, and the regulations governing such policies does vary state to state. When seeking the right approach to fertility in one’s state, it is vital to understand what programs and policies are in place locally that may benefit or hinder the search for treatment. The more clearly businesses understand their own states’ rules, the more robust and comprehensive the fertility benefits packages they can provide their employees.
Before delving into American laws concerning fertility treatments, it is important to understand a few universal guidelines about health insurance that apply throughout the nation. First, healthcare regulations are different for fully insured and self-insured plans. Fully insured plans are the better-known group healthcare plans offered by an insurance carrier. Self-insured plans are fully funded and managed by employers and, unlike fully insured plans, are not subject to state regulations. Furthermore, some states only require employers to provide insurance or comply with regulations if they have a certain number of employees. Finally, an insurance policy must be written in the same state as any regulation that impacts the policy.
Thus, even in a state that mandates that employers must provide fertility coverage with their insurance plan, employees should make sure no loopholes exist to exclude their own workplace. If an employer provides their own insurance plan, has too few employees, or uses a policy not written in the state, they may not have to comply with fertility insurance regulations.
States first began requiring insurers to offer some sort of infertility coverage in the 1980s, but since then, only 17 have passed such laws. Of these states, Arkansas, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, and West Virginia require insurance companies to offer comprehensive fertility treatments. California and Texas only require coverage for diagnosis and, in certain cases, in-vitro fertilization (IVF).
Even among only 17 states, the rules and regulations that govern fertility treatment through health insurance vary dramatically. Arkansas, for example, guarantees a lifetime maximum benefit of at least $15,000, while Hawaii offers a one-time-only benefit covering all outpatient expenses from IVF. As is the case with many rules about health insurance, these laws can be confusing and highly technical: in Illinois, first-time attempts are restricted to four oocyte retrievals, unless the patient bears a child, in which case two more oocyte retrievals may be used toward a second birth, for a maximum potential total of six retrievals, though only businesses with more than 25 employees must provide this benefit. Montana’s regulations apply to HMOs only, while Utah allows adoption indemnities to be used for infertility treatment. No two states are identical.
Regulations in the U.S. are not only varied but always changing, state by state. Sometimes, legislatures pass new laws in reaction to emerging technologies or a growing understanding of what constitutes necessary care. As of March 2021, all insurance plans in New York must cover fertility preservation, such as egg freezing, if deemed medically necessary, such as for patients undergoing cancer treatments that can reduce egg counts. Other states enact policies for reasons of ethics and inclusivity. In the same year, Illinois expanded all fertility treatment insurance to include same-sex couples, women over 35, single women, and women with medical conditions that preclude pregnancies.
An Easier Way: The ARC Fertility Way
If the American approach has one major flaw, it is the lack of standardization. Some state laws are simply superior to others, either by being more broadly applicable, more fair, or better written. Other states provide loopholes for companies to avoid providing the care otherwise mandated. And not every state is as egalitarian as Illinois, since many exclude some beneficiaries based on sexual orientation, age, or preexisting condition.
ARC Fertility offers employees an alternative: a non-insurance-based system which provides comprehensive coverage inclusive of all employees. The ARC approach includes same-sex couples, single parents, and women over 35, for example, and includes innovations such as egg freezing, preimplantation genetic diagnosis and IVF with freeze-all cycles. Unlike an insurance policy, companies pay for the ARC services only when their employees actually use the treatment services, and then only up to the subsidy amount the employer has chosen that meets their budget.
Contact ARC Fertility today and discover how our system meets the highest standards from each state to create a superior, flexible approach that is affordable for any company, in any state.