Illinois Insurance Mandates

Illinois Insurance Mandates

ILLINOIS IS ONE OF 15 STATES THAT MANDATES COVERAGE FOR FERTILITY TREATMENT

There are only 15 states in the United States with an insurance mandate for infertility insurance coverage, and Illinois is one of these states. The law requires certain group insurance plans and health maintenance organizations (HMOs) to provide coverage for the diagnosis and treatment of infertility.

The law requires insurance policies covering employee groups of more than 25 people to provide coverage for infertility. The mandate does not apply to self-insured employers or those whose policies are written outside of Illinois; however, the law may apply in certain situations if an HMO contract was written outside the state, but the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois.

The Illinois law requires that coverage for the diagnosis and treatment of infertility be the same as coverage for any other condition covered by the insurance policy. Coverage extends to such things as testing, prescription drugs, alternative insemination, in vitro fertilization (IVF), embryo transfer, intracytoplasmic sperm injection (ICSI) and the medical costs associated with egg donation or sperm donation. The law requires coverage for up to four egg retrievals unless a live birth takes place after the first egg retrieval. Then, two more egg retrievals for a maximum of three are covered.

Women who are covered under the Illinois infertility insurance mandate are those who are unable to conceive after one year of unprotected sexual intercourse, are unable to sustain a successful pregnancy, have been diagnosed by a physician as having a medical condition that would make conception impossible with unprotected sexual intercourse, or have undergone one year of medically based and supervised methods of conception, including artificial insemination, which a physician has determined to have failed and are not likely to lead to a successful pregnancy. The Illinois infertility insurance mandate was clarified in 2010 to include lesbians with medical conditions that affected their fertility so they did not have to prove that they had had unprotected intercourse with a man for a year in order to receive coverage.

For more information, visit the Illinois Department of Insurance.