This law requires insurance policies that cover more than 25 people and provide pregnancy-related benefits to cover costs of the diagnosis and treatment of infertility. The law defines infertility as the inability to get pregnant after one year of unprotected sex or the inability to carry a pregnancy to term.
Coverage includes, but is not limited to:
- In vitro fertilization (IVF);
- Uterine embryo lavage;
- Embryo transfer;
- Artificial insemination;
- Gamete intrafallopian transfer (GIFT);
- Zygote intrafallopian transfer (ZIFT);
- Intracytoplasmic Sperm Injection (ICSI);
- Four completed egg retrievals per lifetime; and
- Low tubal egg transfer.
Coverage for IVF, GIFT and ZIFT is required only if:
- The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy;
- The patient has not reached the maximum number of allowed egg retrievals;
- The procedures are performed at facilities that conform to standards set by the America Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
The law exempts religious organizations which believe the covered procedures violate their teachings and beliefs. (Illinois Compiled Statutes Annotated, Chapter 215, Sections 5/356m and 125/5-3).
Individual or group policies of accident and health insurance amended, delivered, issued, or renewed in Illinois must provide coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee. The statute references evidence-based standards of care established by ASRM and the American Society of Clinical Oncology and prohibits discrimination by insurers in determining coverage based on an insured individual’s expected length of life, quality of life, disability, medical dependency, other health conditions, personal characteristics or marital status. (Section 356z.29 Coverage for Fertility Preservation Services)