Coverage Mandate 1:
Individual and group health insurance policies must provide coverage for the medically necessary expenses of the diagnosis and treatment of infertility, including, but not limited to, ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer. Conn. Gen. Stat. §§ 38a-509(a); 38a-536(a).“Infertility” means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. Id.
Scope of Mandate 2:
Coverage Cap 3:
The plan may limit coverage:
- to individuals under 40 years of age;
- for ovulation induction to a lifetime maximum benefit of four cycles;
- for intrauterine insemination to a lifetime maximum benefit of three cycles;
- lifetime benefits to a maximum of two cycles, with not more than two embryo implantations per cycle, for IVF, gamete intra-fallopian transfer, zygote intra-fallopian transfer or low tubal ovum transfer, provided each such fertilization or transfer shall be credited toward such maximum as one cycle;
- for IVF, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer to those individuals who have been unable to conceive or produce conception or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures covered under such policy. Nothing in this subdivision shall be construed to deny the coverage required by this section to any individual who foregoes a particular infertility treatment or procedure if the individual's physician determines that such treatment or procedure is likely to be unsuccessful;
- to individuals who have been covered under the plan for at least 12 months.
The plan may:
- Require that covered infertility treatment or procedures be performed at facilities that conform to the standards and guidelines developed by the ASRM or the Society of Reproductive Endocrinology and Infertility; and
- Require disclosure by the individual seeking such coverage to such individual's existing health insurance carrier of any previous infertility treatment or procedures for which such individual received coverage under a different health insurance policy..
Requirements or Limitations on Coverage 4:
Yes, for religious organizations
Any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets. Conn. Gen. Stat. §§ 38a-509(c)(1); 38a-536(c)(1)
“Religious employer” means an employer that is a “qualified church-controlled organization”, as defined in 26 USC 3121 or a church-affiliated organization. Conn. Gen. Stat. §§ 38a-509(e); 38a-536(e).Upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods. Conn. Gen. Stat. §§ 38a-509(c)(2); 38a-536(c)(2).
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.