Fertility treatment is an essential healthcare service for many individuals and families, but access and coverage vary significantly across the United States. Importantly, state fertility mandates apply only to fully insured health plans and do not extend to self-insured employers. As a result, many large employers need to design their own fertility benefits to attract diverse talent and ensure inclusivity. Currently, 19 states have some form of law related to fertility coverage, and 13 of these specifically include IVF in their mandates.
In this blog post, we will break down what services are covered in each state, their volume, and any key limitations.
1. Arkansas
Arkansas mandates coverage for in vitro fertilization (IVF) in fully-insured plans. Coverage is limited to $15,000 per lifetime and applies only if the policy also includes maternity benefits. The law excludes surrogacy and other fertility treatments like egg freezing.
2. California
California has a mandate to offer, meaning insurers must offer coverage for infertility treatments, excluding IVF. However, they are not required to include it in all plans. This law allows employers to choose whether to include infertility services in their health plans.
3. Connecticut
Connecticut provides one of the most comprehensive fertility coverage mandates. It includes IVF, intrauterine insemination (IUI), and fertility preservation. The state limits coverage to four cycles of ovulation induction, three IUI cycles, and two IVF cycles.
4. Delaware
Delaware mandates fertility coverage, including up to six completed egg retrievals and unlimited embryo transfers. This law covers IVF, fertility preservation for medical reasons, and egg freezing, among other treatments. Employers who self-insure or those with fewer than 50 employees are exempt from the requirement.
5. Hawaii
Hawaii mandates insurance coverage for one IVF cycle per lifetime, but the mandate applies only to married couples using their own eggs and sperm, making it restrictive. Surrogacy and egg donation are not covered.
6. Illinois
Illinois mandates IVF coverage, providing up to four completed egg retrievals and two additional retrievals if a live birth results from the initial retrieval. The law applies only to fully-insured plans, with age restrictions for women over 35.
7. Louisiana
Louisiana’s mandate requires coverage for infertility diagnosis and treatment but explicitly excludes IVF.
8. Maryland
Maryland’s mandate covers IVF and fertility preservation, allowing up to three IVF cycles in a lifetime. There are restrictions on age and medical necessity.
9. Massachusetts
Massachusetts has one of the most inclusive mandates, covering IVF, IUI, and fertility preservation. The law includes no exclusions based on marital status or sexual orientation. Surrogacy, however, is not covered.
10. New Hampshire
New Hampshire mandates that fully-insured health plans cover infertility services, including up to four IVF cycles per lifetime. There is an additional requirement that IVF cycles be performed before the individual is 45 years old.
11. New Jersey
New Jersey mandates coverage for IVF, IUI, and fertility preservation, but with restrictions. Coverage is capped at four egg retrievals, and the law does not apply to surrogacy or egg donation.
12. New York
New York mandates IVF coverage for large group insurance plans, providing up to three IVF cycles per lifetime. The law also prohibits discrimination based on age, sex, or sexual orientation. However, surrogacy and egg donation are not covered.
13. Rhode Island
Rhode Island mandates coverage for infertility treatments, including IVF. Coverage is restricted to individuals under the age of 42, with a cap on IVF cycles.
14. Texas
Texas is a mandate-to-offer state, meaning insurers are required to offer fertility treatment options but are not required to cover IVF.
15. Utah
Utah mandates coverage for fertility preservation but not for IVF or other fertility treatments.
Limitations of State Mandates
Most state mandates have significant limitations, including:
- Applicability only to fully insured plans, meaning that large employers who self-insure are not required to follow these mandates.
- Age restrictions (often IVF cycles are only covered for women under 42 or 45 years old).
- Lifetime caps on the number of IVF cycles.
- Exclusions for services like surrogacy, egg donation, and elective egg freezing.
Conclusion
As employers compete for top talent, offering comprehensive fertility benefits is essential. While many states mandate some form of fertility coverage, these mandates often have significant limitations and do not apply to self-insured employers. To attract diverse talent, companies should design inclusive fertility benefits that cover a broad range of services, such as IVF, surrogacy, and egg freezing. Doing so ensures that all employees, regardless of marital status, sexual orientation, or age, have the opportunity to build the family they envision.
The employers that use With Stork Club fertility care benefits are able to close gaps in reproductive care coverage to compete for talent while reducing the total healthcare cost due to improved clinical outcomes (eg fewer high-risk multiple births, fewer IVF cycles to achieve successful results, lower care cost).
