Coverage Mandate 1:
Health carriers must provide coverage for medically necessary fertility treatment, including evaluations, laboratory assessments, medications, and treatments associated with the procurement of donor eggs, sperm, and embryos. N.H. Rev. Stat. § 417-G:2(II).
Health carriers must also provide coverage for the diagnosis of the cause of infertility. Id. § 417-G:2(I).
“Infertility” means a disease where an individual's ability to become pregnant or to carry a pregnancy to live birth is impaired, or where an individual's ability to cause pregnancy and live birth in the individual's partner is impaired. Id. § 417-G:1(V).
“Medically necessary” means health care services or products provided for the purpose of preventing, stabilizing, diagnosing, or treating an illness, injury, disease, or the accompanying symptoms. Id. § 417-G:1(VI).
Scope of Mandate 2:
Applies to health carriers that issue or renew any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses. N.H. Rev. Stat. §§ 417-G:2(I), 417-G:2(II).
“Health carrier” means an entity subject to the insurance laws and rules of the state, or subject to the jurisdiction of the
commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. This includes insurance companies, HMOs, health service corporations, or other entities providing a plan of health insurance, health benefits, or health services. Id. § 417-G:1(IV).Does not apply to plans available through the Small Business Health Options Program or to Extended Transition to Affordable Care Act-Compliant Policies. Id. § 417-G:2(IV).
Coverage Cap 3:
Requirements or Limitations on Coverage 4:
Health carriers may not impose any:
- deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other coverage limitations that are different from those imposed upon benefits for services or medications not related to infertility; or
- pre-existing condition exclusions or pre-existing condition waiting periods or use a prior diagnosis or treatment for infertility as a basis for excluding, limiting or otherwise restricting the availability of coverage; or
- limitations on coverage based solely on arbitrary factors including, but not limited to, number of attempts, dollar amounts, or age.
Health carriers must provide coverage for standard fertility preservation services when a person is expected to undergo surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impaired fertility. N.H. Rev. Stat. § 417-G:2(III).
“Standard fertility preservation services” means procedures consistent with established medical practices and professional guidelines, including the procurement and cryopreservation of embryos, eggs, sperm, and reproductive material determined not to be an experimental infertility procedure. Storage must be covered from the time of cryopreservation for the duration of the policy term. Storage offered for a longer period of time, as approved by the health carrier, must be an optional benefit. Id. §§ 417-G:1(VII), 417-G:2(III).“Experimental infertility procedure” means a procedure for which the published medical evidence regarding risks, benefits, and overall safety and efficacy is not sufficient to regard the procedure as an established medical practice. Id. § 417-G:1(II).
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.