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Maryland

Coverage Mandate 1:

Yes

Effective 10/1/1997.

Insurers, nonprofit health service plans, and HMOs that provide pregnancy-related benefits may not exclude benefits for all outpatient expenses arising from IVF procedures performed on a policyholder, subscriber, or dependent spouse. Md. Code Ann., Ins. § 15-810(c)(2).

Insurers, nonprofit health service plans, and HMOs are not responsible for any costs incurred in obtaining donor sperm. Id. § 15-810(f).

For insurers and nonprofit health service plans, these benefits must be provided to the same extent as the benefits provided for other pregnancy-related procedures. Id. § 15-810(c)(3)(i).

For HMOs, these benefits must be provided to the same extent as the benefits provided for other infertility services. Id. § 15-810(c)(3)(i).

Scope of Mandate 2:

Applies to insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies that are issued or delivered in the state and HMOs that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the state. Md. Code Ann., Ins. § 15-810(a).

Coverage Cap 3:

The insurer, nonprofit health service plan, or HMO may limit coverage to 3 IVF attempts per live birth, which must not exceed a maximum lifetime benefit of $100,000. Md. Code Ann., Ins. § 15-810(e).

Requirements or Limitations on Coverage 4:

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

  • The patient is the policyholder, subscriber, or covered dependent; and
  • The patient has been unable to attain a successful pregnancy through a less costly infertility treatment for which coverage is available under the policy or contract; and
  • The IVF procedures are performed at medical facilities that conform to applicable guidelines or minimum standards.

Md. Code Ann., Ins. §§ 15-810(d)(1), 15-810(d)(5)-(6).

For a married patient whose spouse is of the opposite sex –

  • The patient's oocytes must be fertilized with the patient's spouse's sperm, unless the patient's spouse is unable to produce and deliver functional sperm and this inability is not the result of voluntary sterilization.

Id. § 15-810(d)(2).

For a married patient –

  • The patient and the patient's spouse must have a history of involuntary infertility; or
    • If the patient and the patient's spouse are of opposite sexes, a history of involuntary infertility means intercourse of at least 1 year's duration failing to result in pregnancy.
    • If the patient and the patient's spouse are of the same sex, a history of involuntary infertility means 3 attempts of artificial insemination over the course of 1 year failing to result in pregnancy.
  • The infertility of the patient or the patient's spouse 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, or abnormal male factors.

Id. § 15-810(d)(3).

For an unmarried patient –

  • The patient must have had 3 attempts of artificial insemination over the course of 1 year failing to result in pregnancy; or
  • 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, or abnormal male factors.
Id. § 15-810(d)(4).

Exemptions 5:

Yes, for religious organizations and small businesses

If the coverage requirement conflicts with a religious organization’s bona fide religious beliefs and practices, the religious organization may request, and the insurer, nonprofit health service plan, or HMO must grant an exclusion from the coverage requirement. Md. Code Ann., Ins. § 15-810(i).

The term “religious organization” is not defined.

Small employers are exempt from the coverage requirement. Id. § 15-810(c)(1)(i).

The term “small employer” is not defined.

Fertility Preservation: 

Yes

Effective 1/1/2019.

The law requires coverage for standard fertility preservation procedures that are medically necessary to preserve fertility for a policyholder, subscriber or covered dependent due to a need for medical treatment that may directly or indirectly cause iatrogenic infertility. Md. Code Ann., Ins. § 15-810.1(c).

“Iatrogenic infertility” means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes. Id. § 15-810.1(a)(2).

“Standard fertility preservation procedures” means procedures to preserve fertility that are consistent with established medical practices and professional guidelines, including sperm and oocyte cryopreservation and evaluations, laboratory assessments, medications, and treatments associated with sperm and oocyte cryopreservation. This does not include the storage of sperm or oocytes. Id. § 15-810.1(a)(4).

If a religious organization is granted an exclusion from in vitro fertilization coverage, it may not be required to provide coverage for standard fertility preservation procedures. Id. § 15-810.1(d).

Notes

Md. Code Ann., Health–Gen. § 19-701(f)(2)(vii) includes family planning or infertility services in the definition of “health care services.”

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
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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.