Arkansas

Coverage Mandate ¹:

Yes

Effective 9/2/1991.

All Accident and Health Insurance companies doing business in the state must include IVF as a covered expense. Ark. Code §§ 23-85-137(a), 23-86-118(a); Ark. Admin. Code 054.00.1-5.

The term “IVF” is not defined.

The Insurance Commissioner can suspend or revoke the certificate of authority of any insurance company that fails to comply. Id. at §§ 23-85-137(b), 23-86-118(b).

Cryopreservation shall be included as an in vitro fertilization procedure. Ark. Admin. Code 054.00.1-8.

Scope of Mandate ²:

This rule applies to each individual, group, or blanket disability insurance policy issued, renewed, or delivered in the state, and each certificate of disability insurance issued to a resident of this state under a group disability policy issued outside the state that provides normal pregnancy-related benefits. Ark. Admin. Code 054.00.1-4.

Arkansas Insurance Commissioner guidance suggests this does not apply to HMOs.

It does not apply to:

Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein;
Life insurance, endowment, or annuity contracts, or contracts supplemental thereto, that contain only such provisions relating to accident and health insurance as: (A) Provide additional benefits in case of death, dismemberment, or loss of sight by accident; or (B) Operate to safeguard the contracts against lapse or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract; and
Reinsurance. Ark. Code § 23-85-102.
Specified disease, indemnity, accident-only or other limited benefit policies that do not include maternity benefits. Ark. Admin. Code 054.00.1-4.

Coverage Cap ³:

Permissive

The policy or certificate may include a lifetime maximum benefit of not less than $15,000.00.
Ark. Admin. Code 054.00.1-6.

Requirements or Limitations on Coverage ⁴:

The benefits for IVF must be the same as the benefits provided under maternity benefit provisions and may be subject to the same deductibles, co-insurance and out-of-pocket limitations provided in the policy or certificate that apply to maternity benefits. Any preexisting condition limitation shall not exceed a period of twelve (12) months. Ark. Admin. Code 054.00.1-6.

The patient’s oocytes must be fertilized with the sperm of the patient’s spouse; and
(i) The patient and spouse must have a history of unexplained infertility of at least 2 years in duration, or (ii) the infertility must be associated with one or more of the following: endometriosis, exposure in utero to DES, blockage of or removal of one or both fallopian tubes not a result of voluntary sterilization, or abnormal male factors; and
The IVF must be performed at a medical facility licensed or certified by the state department of health, or another state health department, that conform to the guidelines of the American College of Obstetricians and Gynecologists (ACOG) for IVF clinics; or ASRM for programs of IVF; and
The patient has been unable to obtain successful pregnancy through any less costly applicable infertility treatment for which coverage is available under the health policy.

Ark. Code §§ 23-85-137(d), 23-86-118(d); Ark. Admin. Code 054.00.1-5(B).

Exemptions ⁵:

Yes, for certain types of plans

Minimum basic benefit policies are carved out, and are prohibited from covering IVF. Ark. Code § 23-98-106; Ark. Admin. Code 054.00.52-5.

Ark. Code § 23-79-510(a)(2) provides that the state Comprehensive Health Insurance Pool (CHIP) shall not provide coverage for any expense or charge for IVF, artificial insemination, or other artificial means used to cause pregnancy, unless the contractual policy form language adopted by the board provides otherwise

Fertility Preservation:

Notes

¹ Does the state have a coverage mandate, Y/N. Include effective date of the mandate. Specify if the mandate is to “offer” services or to “cover” them.

²Which insurers are required to comply with the mandate. If not applicable, put N/A.

³Is there a cap (annual/lifetime)?

⁴Does the law impose age restrictions on eligibility for coverage? Does it limit the number of IVF cycles covered (or require at least a certain number of services be covered)? Does it mandate a waiting period? Other limitations? How is “infertility” defined? Is it inclusive (e.g.: does it apply only to married or -opposite sex couples, or is it inclusive?)

⁵What, if any, exemptions apply to coverage under the mandate? For example: an exemption for small businesses or religious organizations.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.