Infertility treatments are very expensive, and there are no guarantees that you will conceive. Health insurance plans that cover IVF and other infertility treatments are hard to find. Fourteen states have laws mandating some level of coverage, but each state mandate is full of holes; most couples have little or no coverage.
If you employer does not offer a group plan with infertility coverage, your chances of finding individual coverage is slim. And if you do find coverage, it comes in the form of a rebate. You get a partial refund if you don’t conceive. But this approach covers your smaller exposure: the cost of infertility treatment that fail. Your costs are just beginning when you conceive.
Wouldn’t it make sense to purchase insurance coverage that pays benefits for you bigger exposure: you conceive and have a baby? Supplemental insurance pays a benefit for your normal delivery. Your benefit may greatly exceed the premium you pay. Use this excess to cover some of your infertility treatment costs.
State Mandates for Group Coverage
Fourteen states have health insurance laws that mandate some form of coverage for infertility treatments, and sometimes for IVF explicitly. If you are fortunate to live in one of these states, or work for an employer headquartered in these state, count yourself very lucky. You have at least some level of coverage.
Couples living in one of these states are not guaranteed infertility coverage. Some states have a mandate to offer coverage. Insurers are required to offer these plans, but employers are not compelled to buy them. Other states limit the mandate to employer groups of a certain size based upon the number of employees. States can only regulate insurers. If your employer self ensures, they are exempt from the regulations. Also if your employer is headquartered in one of the thirty six states with no state mandate, they are exempt as well.
If you live in one of the thirty six states with no mandate, you are on your own.
Individual Health Coverage for Infertility
Most infertility health insurance options sold to individuals are rebate plans. You are refunded a portion of your infertility or IVF treatment cost if you do not conceive and/or delivery a baby. The insurer will provide this option only if you qualify medically.
Many couples find this option appealing – after all who wants to pay lots of money only to get nothing in return? Upon closer inspection, these plans don’t make sense for everybody for three reasons. First, insurer offers the refund program only to couples likely to conceive based upon their extensive knowledge of fertility rates and medical conditions. Second, couples are asked to bet against the insurer who is better informed, and has deeper pockets. Third, this insurance fails to address couples biggest exposure: when happens when they get pregnant?
When infertility treatments fail, you get a portion of your money back. When they work, you pay for the insurance, plus the infertility treatment, and then have to deal with the possibility of a high risk pregnancy, followed by a loss of maternity leave income, followed by the cost of raising a child.
Individual Coverage for Your Bigger Exposure
Supplemental insurance, when purchased preconception provides a means to cover some of your infertility treatment costs, and protect you in case of complications. Your benefit for normal delivery may greatly exceed the premium you pay. Use this excess to fund some of your infertility treatment costs. Plus, you have extra security in case of complications, premature birth, accidents and illnesses – all at no additional cost.