Specialists in Reproductive Medicine & Surgery, P.A.
Craig R. Sweet, M.D.
Board Certified in Reproductive Endocrinology & Infertility and Obstetrics & Gynecology
Dedicated to excellence in reproductive medicine

What Are The Past & Pending Infertility Insurance Mandates/Legislation?

Quick Jumps:

•  Do Any States Currently Mandate Infertility Insurance Coverage?
•  What States Are Considering Infertility Insurance Coverage Legislation?
•  Is There Any Pending Federal Legislation?

Do Any States Currently Mandate Infertility Insurance Coverage?

    In addition to paying close attention to the progress of the Saks case and other state and federal cases regarding the definition of disability and the provision of insurance coverage for infertility treatment, we should also watch what is happening in the state legislatures across the nation. A mandate to offer means there is law that requires health insurance companies at least offer to cover infertility diagnosis and treatment. A mandate to cover generally means that health insurance companies must provide infertility diagnosis and treatment for all policyholders.

    Currently, there are 13 states that either mandate to offer or mandate to cover infertility diagnosis and treatment as briefly summarized below:

    A detailed discussion regarding each of the 13 state laws is beyond the scope of this work. Suffice it to say that each state law is different and it is recommended that you contact your state’s Insurance Commission for additional information.

What States Are Considering Infertility Insurance Coverage Legislation?

    Legislative advocacy efforts are listed below for the following states:  Florida, Indiana, Maine, Michigan, Nevada, New Hampshire, New York, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, Washington State and Wisconsin. An excellent summary of the ongoing legislation with links to the various states can be found at http://www.resolve.org/advstate.htm.

Is There Any Pending Federal Legislation?

    There are currently three bills, which are currently under some level of consideration at the Federal level.

    H.R. 2774 was sponsored by Representative Marty Meehan (D-MA). This bill amends chapter 89 of title 5, United States Code and provides that any health insurance plan, which provides OB coverage, will have to cover for the diagnosis and treatment of infertility and recurrent pregnancy loss, including non-experimental [including IVF, Gamete Intra-Fallopian Tube Transfer (GIFT), Zygote Intra-Fallopian Tube Transfer (ZIFT)] Assisted Reproductive Technologies (ART). Here are some other proposed requirements of the bill:

•  Coverage will not be subject to copayments or deductibles greater than those that apply to OB benefits.

•  The ART facility must comply with nationally recognized standards and certification organizations.

•  This bill would require federal employees’ health plans to cover infertility services.

•  If a patient achieves success on the third or fourth attempt, two additional attempts will be covered (six lifetime maximum).

•  It would appear that coverage would only be provided if the patient had not already undergone four ART procedures previously. This actually makes some sense since those individuals may be better served through adoption or possibly egg donation.

•  If there are certain religious restrictions (i.e., Catholicism), these health plans will not be required to cover infertility treatments they find objectionable.

•  Interestingly, two physicians, one who “specialize” in infertility, must make the diagnosis. It may be more cost effective to remove this requirement.

    Nonexperimental ART procedures will be determined by the American Society for Reproductive Medicine (ASRM), the American College of Obstetrics & Gynecology (ACOG) and other similar nationally recognized organizations or Federal agency.

    H.R. 2774 was sent to the House Committee on Government Reform. As of 7/2000, there were 14 cosponsors to the bill.

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    H.R. 2706, sponsored by Representative Anthony Weiner (D-NY). This act is being called the Family Building Act of 1999. The goal was to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 5, United States Code, to require coverage for the treatment of infertility.

    The wording of this bill was intriguing in that it admits that, “A fundamental part of the human experience is fulfilling the desire to reproduce.” An astute comment, indeed.

    This plan provides greater detail and specifically covers IVF, GIFT, ZIFT, Intra-Cytoplasmic Sperm Injection (ICSI) and other common ART treatments. Some of the other specifics of the bill are as follow:

•  It was interesting that experimental vs. non-experimental services would be determined by the Secretary of Health and Human Services following consultation with the American Society of Reproductive Medicine (ASRM), the American College of Obstetrics & Gynecology (ACOG) and RESOLVE. With all due respect to RESOLVE, it is uncertain how RESOLVE will be able to discuss scientific merits of various procedures. Nevertheless, they will offer the patient perspective.

•  Up to four cycles would be covered without success and up to six if there was a live birth success from the process.

•  This bill proposes that the process be re-reviewed every five years.

•  Deductibles, coinsurance, and other cost-sharing or other limitations for infertility therapy may not be imposed to the extent they exceed the deductibles, coinsurance, and limitations that are applied to similar services under the group health plan or health insurance coverage.

    The bill was sent to the House Committee on Government Reform, the House Commerce Committee, and the House Committee on Education and the Workforce. As of 7/2000, there were 17 cosponsors on the bill.

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     United States Senator Robert G. Torricelli, a Democrat from New Jersey, introduced the Fair Access to Infertility Treatment and Hope Act of 2000 (FAITH: S. 2160) on 3/2000.

     This bill seems to be the most expansive of those offered. This bill proposes the following:

• Group health care plans are to offer the evaluation and treatment of infertility.

• Treatment includes insemination procedures and medications.

• Coverage will allow for ART procedures including egg donation, embryo donation and "low tubal ovum transfers" (GIFT?). From what we can tell, four embryo transfers will be allowed. If a pregnancy and live birth occur with the 4th transfer, an additional two transfers will be offered.

     Under this proposed legislation, the health care plan is forbidden to do the following:

• Provide monetary payments or rebates to a covered individual to encourage such individual to accept less than the minimum protections available.

• Provide incentives (monetary or otherwise) to a health care professional to induce such professional to withhold from a covered individual services. This is interesting in that some managed care plans offer physicians end-of-year bonuses if utilization is minimized.

     Deductibles, limitations or cost-sharing programs will be allowed but must be fair throughout the program.

     Required coverage for infertility benefits for federal employees will be offered.

     This proposed legislation covers a large number of areas and will probably encounter an equally expansive level of opposition. We are uncertain where this legislation is in the "pipeline" and will keep close track of it when more information becomes available. As of 7/2000, there were no cosponsors for the bill.

     There is currently an on-line petition which you can sign. Please press here to access it.

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     RESOLVE has an excellent web page with the various addresses and e-mail addresses of the chairs and the members of the committees currently involved in H.R. 2774 and 2706. These can be obtained by visiting http://www.resolve.org/advcommittee.htm.

     Additional information on the bills themselves can be found by visiting http://thomas.loc.gov/home/thomas.html and searching under “H.R. 2774” and “H.R. 2706”.  

     You may obtain information about S. 2160 by visiting http://www.senate.gov/index.cfm and typing "S. 2160" in the lower left-hand corner under "Number" and then press "go".

     You may also review a letter that Dr. Sweet recently sent to his patients by downloading the pdf letter below:

(Patient Letter, 18 kb, 72 dpi, screen optimized)
(Patient Letter, 67 Kb, 300 dpi, print optimized)

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