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Delaware

Coverage Mandate 1:

Yes

Effective 6/30/2018.

Individual, group, and blanket health insurance policies must include coverage for fertility care services, including IVF, for individuals who suffer from infertility. Del. Code Ann. tit. 18, §§ 3342(i)(2), 3556(i)(2).

These benefits must be provided to covered individuals, including covered spouses and covered non-spouse dependents, to the same extent as other pregnancy-related benefits. Id.

“Infertility” means a disease or condition that results in impaired function of the reproductive system whereby an individual is unable to procreate or to carry a pregnancy to live birth. Id. §§ 3342(i)(1)(b), 3556(i)(1)(b).

Scope of Mandate 2:

Applies to all individual, group, and blanket health insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in the state by any health insurer, health service corporation, or HMO, and that provide for medical or hospital expenses. Del. Code Ann. tit. 18, §§ 3342(i)(2), 3556(i)(2).

Coverage Cap 3:

No

A policy, contract, or certificate may not impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for required fertility care services, which are different from those imposed upon benefits for services not related to infertility. Del. Code Ann. tit. 18, §§ 3342(i)(4), 3556(i)(4).

Requirements or Limitations on Coverage 4:

To qualify for coverage, all of the following requirements must be met:

  • A board-certified or board-eligible obstetrician-gynecologist, subspecialist in reproductive endocrinology, oncologist, urologist, or andrologist verifies that the covered individual is diagnosed with infertility or is at risk of iatrogenic infertility.

  • When the covered individual is diagnosed with infertility, the covered individual has not been able to obtain a successful pregnancy through reasonable effort with less costly infertility treatments covered by the policy, with the following exceptions:

    • No more than 3 treatment cycles of ovulation induction or intrauterine inseminations may be required before IVF is covered.

    • If IVF is medically necessary, no cycles of ovulation induction or intrauterine inseminations may be required before IVF is covered.

  • IVF procedure must be performed at a practice that conforms to American Society for Reproductive Medicine and American Congress of Obstetricians and Gynecologists guidelines.

  • For IVF, retrievals are completed before the individual is 45 years old and transfers are completed before the individual is 50 years old.
Del. Code Ann. tit. 18,  §§ 3342(i)(3), 3556(i)(3).

Exemptions 5:

Yes, for religious organizations, small businesses, and self-insurers. These exemptions only apply to group or blanket policies

A religious employer may request, and the plan must grant an exclusion from the coverage requirement, if the coverage requirement conflicts with the religious organization’s bona fide religious beliefs and practices. If such employer obtains an exclusion, it must provide its employees reasonable and timely notice of the exclusion. Del. Code Ann. tit. 18, § 3556(i)(5).

The term “religious employer” is not defined.

Employers who self-insure or who have fewer than 50 employees are exempt from the coverage requirements. Id. § 3556(i)(6).

Fertility Preservation: 

Yes

The law requires coverage for standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility. Del. Code Ann. tit. 18, §§ 3342(i)(2), 3556(i)(2).

These benefits must be provided to covered individuals, including covered spouses and covered non-spouse dependents, to the same extent as other pregnancy-related benefits. Id.

“Iatrogenic infertility” means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment. Id. §§ 3342(i)(1)(a), 3556(i)(1)(a).

“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines published by professional medical organizations. Id. §§ 3342(i)(1)(c), 3556(i)(1)(c).

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.
ReproductiveFacts.org
is a patient education website of ASRM.
 

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For more information

  • If you have questions about insurance laws in your state or territory, please call your state or territory's Insurance Commissioner's office.
  • To learn about pending legislation in your state or territory, please contact your State or Territory Representatives.

The Employment Retirement Income and Security Act of 1974 exempts companies that self-insure from state regulation.