Coverage Mandate 1:
Effective April 11, 2021Health insuring corporations must cover “basic health care services,” which are defined to include “infertility services” when medically necessary. Infertility is not defined. Ohio Rev. Code §§ 1751.01; 1751.02 (2021). The standard for determining medical necessity with respect to infertility services is not defined.
Scope of Mandate 2:
Mandate does not apply to MEWAs or Medicaid.
Ohio Rev. Code 1751.02 (2021); Ohio Admin. Code 5160-1 (2015).“Basic health care services” does include experimental procedures. Ohio Rev. Code 1751.01 (2021). “Experimental procedures” is not defined.
Coverage Cap 3:
Requirements or Limitations on Coverage 4:
Ohio’s statute does not define “infertility services” or otherwise describe the character of covered services, nor do any state regulations.
https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/ cites to Ohio Rev. Code Ann. 1751.01(A)(7) – which is not a numeration that exists in the current code. This source states that the above section discusses the obligations of HMOs, but I was unable to find law on HMO coverage mandates.
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.