What is Infertility Insurance?

A. Leverkuhn

When health care or legal professionals talk about infertility insurance, they are often talking about a component of a medical insurance plan that covers conditions of infertility. Infertility insurance is most often a portion or “rider” of an overall major medical insurance policy. The infertility insurance coverage mandates how the insurance company must pay for claims, procedures and subsequent charges related to infertility.

A diagram of a healthy ovary and one with cysts, which can contribute to infertility.
A diagram of a healthy ovary and one with cysts, which can contribute to infertility.

Each state has its own guidelines on major medical insurance coverage. Infertility coverage differs respectively, according to the state of residence of the couple. With many Americans trying to have babies each year, states often look at their rules on infertility insurance coverage. Infertility procedures can be incredibly expensive compared to median annual incomes, which raises many questions about how this care is provided. Often, families must be their own advocates, and demand the funds that they are due from an insurance company.

Infertility insurance covers conditions related to infertility.
Infertility insurance covers conditions related to infertility.

Causes of infertility may influence whether infertility insurance coverage is relevant to a specific situation. Many states also have a standard period of time that defines “infertility” for a couple. Likewise, male infertility and female infertility may be treated differently by health insurance companies. All of these factors make dealing with infertility insurance a complicated task.

A woman or couple may pursue a case over infertility insurance coverage if they feel that a health insurance company has denied a claim in error. Legal representatives may get involved in assessing a case based on infertility insurance coverage. Again, outcomes can hinge on aspects of the larger major medical policy that includes an infertility component.

Experts recommend careful observation of existing medical insurance policies for couples who want to conceive. Additional insurance may be available in some cases. A lack of other funding options may make infertility coverage a more popular legal issue in many states.

Additional concerns about infertility coverage stem from the nature of an employment-based medical health system that makes many Americans eligible or ineligible for certain kinds of care based on changing conditions, i.e. employment. The federal COBRA insurance continuation program can be a source of continued medical insurance coverage for many who lose their jobs. This resource can also provide for partial or total infertility coverage for couples.

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