Your health insurance policy will dictate what fertility treatment is covered, whether you have IVF insurance coverage, what health care provider can provide this treatment, what infertility tests you can have, the sequence of those tests, and what fertility medications you can use. In short, unless you are independently wealthy, it dictates everything.
Every policy provides different coverage, with most policies not covering fertility treatment at all. You have to know your policy, specifically, what are “covered benefits”, “exclusions” and “restrictions”.
You have to be your own best advocate, but most infertility clinics have someone on staff that can help you understand your policy.
- No Fertility Insurance Coverage: Although, not common, it is possible. Most health insurance policies usually cover at least some aspects of the infertility diagnosis, even if it does not cover treatments such as in vitro fertilization. Diagnosis and treatment of conditions such as Polycystic Ovarian Syndrome (PCOS) and endometriosis are usually covered.
- Insurance Coverage for Infertility Diagnosis Only: This is the most common. Insurance policy covers diagnosing the cause of infertility. It may cover surgeries necessary to diagnosis the cause and may specify what type of health care provider can perform these tests and surgeries.
- Insurance Coverage for Infertility Diagnosis and Limited Treatment: Insurance benefits cover diagnosing the cause of infertility and limited treatment options such as clomiphene citrate (Clomid), artificial insemination/intrauterine insemination (IUI) with or without injectable medications.
- Full Infertility Insurance Coverage: Wonderful, but rare outside of states that require insurance companies to offer fertility insurance coverage. Usually there is either a limit on the number of IVF cycles that are covered or a lifetime dollar amount limit to be used for fertility treatment.
- What diagnosis procedures your insurance covers?
- What treatments are covered? (How many IVF cycles are covered? Is there a lifetime monetary limit?, etc.)
- What procedures require preauthorization?
- What drugs are covered?
- Are there any restrictions on who can deliver treatment?
- Get a copy of your health care plan’s Evidence of Coverage or Certificate of Insurance from your employer’s human resource department or by calling up your insurance company. The Summary of Benefits is usually not sufficient for the information you will need. If you already have a copy of this document, make certain it is the latest version. They change frequently.
- Ultimately you are responsible for knowing your insurance coverage for infertility, but you can get help from the following:
- The insurance company
- The human resources department at your employment
- The infertility clinic you are considering or are using
- Infertility is a disease and deserves to be covered by insurance. We must do all we can to help educate others. We need you as an advocate for fertility insurance coverage. The best place to keep informed about advances and threats to insurance coverage for infertility is the Center for Infertility Justice at the Resolve website.
- Ask your employer to provide insurance that covers infertility. Most employers who offer this coverage do so at the request of their employees. Ask!
Insurance for Egg Donation and Surrogacy
Intended parents considering egg donation or surrogacy may very well need to purchase insurance coverage for the egg donor and surrogate. Depending on where they live they may also need to purchase insurance to cover the newborn.
Creating a Family has many resources on infertility insurance to cover fertility treatment, egg donors, and surrogates. Here are a few we think you will find particularly helpful:
- Is Infertility Really a Disease? (blog post)
- 11 Tips for Using Health Insurance to Cover Fertility Treatment (blog post)
- Infertility Treatment for Military Personnel and their Partners (blog post)
- Getting the Most Out of Insurance Coverage for Fertility Treatment (1 hr. radio interview w/ experts)
- Infertility Advocacy (1 hr. radio interview w/ experts)
Many more Creating a Family radio interviews with experts, videos, blogs, fact sheets, and Q and A’s with Experts on infertility insurance coverage can be found at the icons below.
Sources: Creating a Family radio shows below, www.fertilitylifelines.com, Budgeting for Infertility by Dr. Evelina Sterling and Angie Best-Boss
Image credit: Judy Van der Velden
Additional Resources
