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Home arrow Resources arrow Articles arrow What is Infertility Benefits Coverage?

What is Infertility Benefits Coverage?

Infertility insurance covers a wide range of insurance benefits that relate to infertility and conception. California is currently one of only 15 states that has an infertility insurance mandate. California Infertility Health Insurance laws mandate that insurers offer coverage for diagnosis and treatment of infertility as an option. There are a few important facts to know about infertility benefits before you invest in a supplemental policy or sign up for employer offered benefits.

What Infertility Insurance Covers

It's always important to know what you're getting when you purchase infertility coverage whether it's as a rider to your personal health insurance plan or if it's employer offered infertility coverage. Common services covered by infertility insurance coverage include: diagnosis and treatment of infertility, artificial insemination (though there may be limits), Gamete Intra-Fallopian Transfer (GIFT) -- again with likely limits, and prescriptions drug coverage for infertility medications. Compare your options before you decide which policy best meets your needs or coincides with your infertility treatment goals.

The Importance of Infertility Benefit Coverage

Infertility treatments can get very expensive before any forms of insemination is even considered. The diagnostic process alone is a huge expense for couples who are trying to conceive. When this is combined from the extra missed time from work and other financial issues couples going through this process face, the financial aspect of treatments and diagnosis become even more profound.

Infertility coverage benefits help struggling couples lower the costs of infertility treatment. Granted, it does not cover 100 percent of the costs of treatment. Most policies only cover a fraction of the costs. However, every dollar saved is another dollar left to invest in your baby's nursery. Or it can be used to help cover additional time off work after baby's grand entrance into your home and your heart.

Limitations of Infertility Benefit Coverage

There are limits to infertility benefit coverage. This is the case for all health insurance and not something that is isolated to infertility benefits. For the most part, there are specific requirements that must be met for the treatment plan to be defined as "infertility" treatments. Services related to surrogacy are not covered by most infertility benefit plans. Neither are Zygote Intra-Fallopian Transfers (ZIFTs). Artificial insemination isn't typically covered if there is no official diagnosis of infertility either.

The best course of action is to consult your plan closely and consider getting pre-approval of coverage from your insurance provider. Do this before you engage in expensive procedures about which you have questions. This will save you peace of mind, if nothing else. However, it can save you thousands of dollars.

You should also note that women who go through infertility treatments, specifically any type of artificial insemination, often experience high-risk pregnancies. In some cases, they are required to miss several weeks if not months of work prior to the birth of their babies. In California, women will receive some pay for this type of leave, but typically hovers around 55 percent of your traditional salary. There are supplemental disability policies you can purchase that offer additional coverage. They are well worth considering.

Exclusions of Infertility Benefit Coverage

In the state of California, where infertility benefit coverage is mandated, there is one specific exclusion to the coverage mandate. Here, infertility insurance isn't required to offer coverage for in vitro fertilization. Under the California mandate, infertility tests, fertility medications, GIFT transfers, and required surgeries are covered. Some employers are specifically exempt from offering coverage for infertility. These include employers who are headquartered in another state and religious organizations and their subsidiaries.

Infertility benefits coverage can be a financial lifeline for couples who are having difficulty conceiving. It's important to understand the scope and scale of your policy however, so that you are fully aware of the financial contribution you'll be expected to make toward your fertility treatment and what types of services are excluded in your plan's coverage.

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