Coverage Mandate 1:
The mandate applies to:
- Any blanket or general policy of insurance (except supplemental insurance) providing hospital or surgical benefits including pregnancy-related benefits issued or renewed anywhere;
- Any policy of accident or sickness insurance or employee health & welfare fund providing hospital or surgical benefits including pregnancy-related benefits delivered, issued, renewed in the commonwealth
These policies must provide to residents, to the same extent as benefits are provided for other pregnancy-related conditions, coverage for medically necessary expenses of diagnosis and treatment of infertility.
“Infertility” means being unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or of 6 months if the female is over the age of 35. If a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1 year or 6 month period, as applicable.Mass. Gen. Laws Ch. 175 § 47H.
Scope of Mandate 2:
Applies to blanket or general policies issued in or out of the commonwealth, accident or sickness policies issued within the commonwealth, and employee health & welfare funds issued within the state. The mandate only applies to these policies if they already offer pregnancy-related benefits.
Mass. Gen. Laws Ch. 175 § 47H
Applies to subscription certificates issued by medical service corporations in the commonwealth when that certificate covers other pregnancy-related benefits.
Mass. Gen. Laws Ch 176B § 4J
Applies to insurance offered as part of an individual or group hospital service plan issued in the commonwealth when that contract covers other pregnancy-related benefits.
Mass. Gen. Laws Ch 176A § 8K.
Applies to health maintenance organizations
Mass. Gen. Laws Ch 176G § 4.
Coverage Cap 3:
Requirements or Limitations on Coverage 4:
Yes, supplemental policies.
Policies offering supplemental insurance to Medicare or other government insurance programs are excepted from this section.Mass. Gen. Laws Ch. 175 § 47H.
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.