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Maryland

The Maryland law requires health and hospital insurance policies issued or delivered in Maryland that provide pregnancy-related benefits to also cover the outpatient costs of in-vitro fertilization. HMO's must provide IVF benefits to the same extent as the benefits provided for other infertility services. 

Coverage may be limited to three in vitro fertilization attempts per live birth and a maximum lifetime benefit of $100,000. The IVF is to be performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

Patients need to meet the following conditions in order to get their IVF covered:

The patient must be a policyholder or subscriber or a covered spouse of the policyholder of subscriber and the patient is unable to get pregnant through less expensive covered treatments.

For patients whose spouse is of the opposite sex:

  • The patient and his or her spouse must have at least a two-year history of infertility; OR their infertility must be associated with one or more of the following conditions:
    • Endometriosis;
    • Fetal exposure to diethylstilbestrol, also known as DES;
    • Blocked or surgically removed fallopian tubes; or
    • Abnormal male factors, including oligozoospermia.
  • The patient's eggs must be fertilized with her spouse's sperm;
  • The patient is unable to get pregnant through less expensive covered treatments;
For patients whose spouse is of the same sex, there must be six attempts of artificial insemination over the course of 2 years failing to result in a pregnancy.  Entities covered by this article are not responsible for costs of acquiring donor sperm.

A religious organization may, by request, have this coverage excluded from its policies and contracts if the required coverage conflicts with its bona fide religious beliefs and practices.

Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide the IVF coverage.

(Maryland Insurance Article §15-810, Health General Article §19-706 Annotated Code of Maryland 2017 Replacement Volume).

Insurers, nonprofit health service plans, and HMOs that provide hospital, medical or surgical benefits to individuals or groups under contracts or policies issued or delivered in Maryland are required to provide standard fertility preservation services to a covered policyholder, subscriber, or their covered dependent when medically necessary to preserve fertility due to a need for medical treatment that may directly or indirectly cause iatrogenic infertility. Standard fertility preservation procedures include sperm and egg cryopreservation and associated testing, medications, and treatment consistent with established medical practice and the professional guidelines of ASRM, ACOG, and ASCO.  Religious organizations exempt from the requirement to cover IVF may not be required to cover fertility preservation. (Maryland Insurance Article §15-810.1)
ReproductiveFacts.org
is a patient education website of ASRM.
 

Zika