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Infertility Treatments and Insurance: 5 Steps to Determine Coverage


Although many insurance companies do not specifically cover infertility treatments, that doesn’t mean every infertility treatment is excluded. Many plans may provide limited infertility insurance coverage or may be required, under state mandate, to provide some coverage. Below are 5 steps to help you determine what, if any, coverages your insurance may provide for infertility treatments:

1.Find out if you live in a state where insurance companies are mandated by that state, or are required to provide specific coverages. You can find out if your state mandates specific insurance coverages by checking with your state’s insurance commissioner. Some states are considering mandated coverages for infertility treatments in the near future and are constantly changing coverages so you will want to keep up to date on current legislation.

2.Obtain a copy of your insurance policy. I am not talking about the one page list of coverages and deductibles you got in the beginning, but instead you will need to look at a larger pamphlet of complete coverages and exclusions. You can request this from your insurance carrier.

3.Next, look to see if infertility coverage is specifically excluded. If you do not see a specific exclusion then the insurance company must cover anything that they do not specifically exclude.

4.After looking in the exclusions, take a look through the policy for the section relating to infertility or pregnancy to see if you can find any limited infertility treatments that may be included in your policy.

5.If you want to take things a step further and feel you have a right to infertility treatment coverages, you can hire an attorney to possibly pursue the matter with your insurance company or your employer under the ADA or Americans With Disabilities Act and/or the EEOC or the Equal Employment Opportunity Commission. Infertility is arguably a disability and inclusion of infertility treatments in insurance is constantly evolving

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