Coverage Mandate 1:
Health Maintenance Organizations are required to cover “basic health services” which are defined to include infertility services.W. Va. Code § 33-25A-2. (“Basic health care services” means physician, hospital, out-of-area, laboratory, . . . emergency, . . . and cost-effective preventive services including immunizations, well-child care, periodic health evaluations for adults, voluntary family planning services, infertility services, . . . which services need not necessarily include all procedures or services offered by a service provider.”)
Scope of Mandate 2:
Coverage Cap 3:
Requirements or Limitations on Coverage 4:
West Virginia’s statute does not define “infertility services” or otherwise describe the character of covered services, nor do any state .
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.