Fertility insurance benefits

Fertility insurance benefits are a subset of health insurance benefits that pay for diagnosis and treatment of infertility. Insurance plans in fifteen states, including New York and Illinois, must offer or cover certain fertility treatments by law.

Benefits commonly cover consultations, diagnostic tests such as semen analysis or bloodwork, and procedures like intrauterine insemination (IUI). Most insurers exclude elective egg freezing, with only five states–New York, Connecticut, Delaware, Illinois, and Rhode Island–mandating coverage.

IVF (in vitro fertilization) receives partial coverage in only twelve mandated states. Employers with over 50 employees often provide fertility benefits due to workforce demand; 44% of large U.S.

Firms offered some form of fertility benefit in 2022 according to Mercer. Fertility drug coverage varies widely between plans and may include medications like Clomid or gonadotropins, per YourInsuranceInfo.

Out-of-pocket limits usually apply to fertility services, with average maximums ranging from $10,000 to $25,000 per lifetime per person. LGBTQ+ individuals can access fertility benefits if their policies explicitly include non-heterosexual couples or single parents.

Fertility benefits rarely cover experimental procedures such as mitochondrial donation or uterine transplants. Coverage requires prior authorization and demonstration of medical necessity through failed attempts at natural conception, typically documented over six to twelve months depending on age.