Coverage Mandate 1:
Yes – however, the scope is limited
All individual and group health benefit plans issued or renewed in the state must provide coverage for the diagnosis of and treatment for infertility, and standard fertility preservation services. Co. Stat. § 10-16-104(23)(a); 3 CCR 702-4:4-2-42.
“Infertility” means a disease or condition characterized by: (i) The failure to impregnate or conceive; (ii) A person's inability to reproduce either as an individual or with the person's partner; or(iii) A licensed physician's findings based on a patient's medical, sexual, and reproductive history, age, physical findings, or diagnostic testing. Id. at § 10-16-104(g)(VI).“Diagnosis of and treatment for infertility” means the procedures and medications recommended by a physician licensed by the Colorado medical board to practice medicine in the state, that are consistent with established, published, or approved medical practices or professional guidelines from ACOG or ASRM for diagnosing and treating infertility. Id. at § 10-16-104(g)(IV).
Scope of Mandate 2:
Coverage Cap 3:
NoThe law does not mandate any cap, but only requires plans to cover three completed oocyte retrievals – so, plans could impose a three procedure cap.
Requirements or Limitations on Coverage 4:
Plans must cover three completed oocyte retrievals with unlimited embryo transfers, using single embryo transfers when recommended and medically appropriate. Co. Stat. § 10-16-104(23)(b).
Plans may not impose any:
- exclusions, limitations, or other restrictions on coverage of fertility medications that are different from the exclusions, limitations, or other restrictions imposed on any other prescription medications covered under the health benefit plan; or
- deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations on coverage for the diagnosis of and treatment for infertility and standard fertility preservation services that are different from deductibles, copayments, coinsurance, benefit maximums, waiting periods, or other limitations imposed on benefits for services covered under the health benefit plan that are not related to infertility. Id. at § 10-16-104(23)(c).
Yes, for religious organizationsA religious employer may request, and the plan must grant an exclusion from the coverage requirement here if the coverage requirement conflicts with the religious organizations bona fide religious beliefs and practices. If such employer obtains an exclusion, it must provide its employees reasonable and timely notice of the exclusion. Co. Stat. § 10-16-104(23)(e).
YesThe law requires health plans to cover “standard fertility preservation services,” which are defined as “procedures and services that are consistent with established medical practices or professional guidelines published by ASRM or ASCO for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.” Co. Stat. § 10-16-104(g)(VIII).
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.