Guide to Fertility Insurance Laws in New England
This post was updated on May 15, 2023 to reflect the most up to date information, especially as it relates to the state of Maine who previously had no fertility coverage mandates.
For individuals or couples experiencing infertility, navigating the costs of treatment can be difficult and confusing. Our financial experts are available to discuss your payment options and gain a more informed understanding of what their insurance may or may not cover. Fertility insurance laws vary significantly from state to state, and it’s important to determine how these laws may impact your total fertility treatment cost. Read on for our guide on fertility insurance laws in New England.
We believe that everyone deserves to build their dream family, regardless of cost. For that reason, we’ve created this guide to fertility insurance laws in New England to help you determine your treatment costs and better plan your path to parenthood.
Questions to Ask Your Employer
If your health insurance is through your job, the first step you should take to determine what your insurance may or may not cover is to talk to your employer or Human Resources department. There are a few important questions to ask:
- Am I fully insured or self-insured? Fully insured plans are required to follow state insurance laws, whereas self-insured or self-funded insurance plans are exempt from state law.
- Do I have a “greater than 25” plan, “greater than 50” plan, or other? Employers with fewer than a set number of employees do not have to provide coverage if the law specifically outlines that exemption. Also, coverage in some states may be limited to the individual, small, or large group insurance markets.
- Was my policy written in the governed state? In most cases, the insurance policy must be written and/or reside in the state that has an infertility insurance law in order for those laws to take effect.
If you are self-insured, we recommend reaching out to your insurance representative or talking to our team to get the answers you need to take the next step.
Understanding Your State’s Fertility Insurance Laws
As of June 2022, 20 states have passed infertility insurance laws—14 of which include IVF. Keep in mind that the basic definition of infertility differs in each state, and, accordingly, coverages and exemptions may also look different. It’s important to be aware of what your state’s fertility insurance laws include and exclude in order to plan your next steps.
Here’s a breakdown of infertility insurance laws in each New England state.
Connecticut Fertility Law
Infertility Definition: The condition of an otherwise healthy individual who is unable to conceive or produce conception or to sustain a successful pregnancy during a one-year period.
Connecticut law requires health insurance to cover medically necessary expenses in the diagnosis and treatment of infertility, including IVF. However, this was amended in 2005 to give an exemption to coverage that is contrary to the religious beliefs of an employer or individual.
Rhode Island Fertility Law
Infertility Definition: The condition of an otherwise healthy married individual who is unable to conceive or produce conception during a one-year period. This was amended in 2007 to increase the age of coverage from 40 to 42 and redefines infertility to mean a woman who is unable to sustain pregnancy during a one-year period.
Rhode Island requires health insurance to cover medically necessary expenses for the diagnosis and treatment of infertility. Additionally, co-payments for infertility services cannot exceed 20%.
Massachusetts Fertility Law
Infertility Definition: The condition of anyone who is unable to conceive during a one-year period if the female is under the age of 35, or during a six-month period if the female is over the age of 35. Please note that if a woman conceives but cannot carry that pregnancy to live birth, the period of time she attempted to conceive prior to pregnancy is included in that one-year or six-month period.
Massachusetts requires general insurance policies, non-profit hospital service corporations, medical service corporations, and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including IVF.
New Hampshire Fertility Law
Infertility Definition: A disease caused by illness, injury, underlying disease, or condition where a woman’s ability to conceive or carry a pregnancy to live birth is impaired. It also includes situations where a man’s ability to cause pregnancy and live birth in his partner is impaired.
New Hampshire requires group health insurance plans (purchased through employers) to cover services related to the diagnosis of infertility, treatment, and fertility preservation. Insurers cannot impose cost-sharing mechanisms, waiting periods, or benefit limits on this coverage. Self-funded health plans offered through employers are exempt from this law, as are SHOP plans and Extended Transition to Affordable Care Act Compliant Policies.
Vermont Fertility Law
Vermont has no mandated infertility coverage; however, you may be eligible for coverage if you live in Vermont and work in New Hampshire. Check with your Human Resources department to determine which state your company’s health insurance is purchased through.
Maine Fertility Law
Infertility Definition: A confirmed medical condition that affects fertility or the inability of a couple to conceive a child after 12 months of unprotected intercourse despite possessing the necessary gametes for conception. This includes instances where a pregnancy is lost within the 12-month period or when conception does not occur in less than 12 months due to age or other factors. It’s important to note that experiencing a pregnancy loss does not reset the 12-month timeframe for trying to conceive.
Effective January 1, 2024, a carrier offering a health plan in Maine is responsible for providing coverage to an enrollee that includes options for fertility diagnostic care, fertility treatments if the enrollee is a fertility patient, and fertility preservation services.
Defining Mandated Fertility Insurance Coverage
You may be wondering what a state “mandate” for fertility insurance coverage means. A “mandate to cover” is where state law requires health insurance plans sold by licensed insurers to include coverage for a specific benefit (in this case, infertility treatments). There is also a “mandate to offer,” which is when state law requires health insurers to offer coverage, but the person or group buying the policy doesn’t necessarily have to elect coverage for that benefit. Connecticut, Rhode Island, Massachusetts, and New Hampshire all have mandates to cover infertility treatment, so long as the state’s requirements for coverage are met.
Regardless of your insurance coverage, we’re here to help you get the treatment you need. We offer free initial consultations to anyone without fertility insurance, normally valued between $350 and $450. If you have more questions about our guide to fertility insurance laws in New England or want to inquire about financing options, please contact us!