Delaware Joins States Requiring Coverage of IVF and Fertility Preservation
Jul 02, 2018
Origin: ASRM Bulletin
Delaware Governor John Carney signed into law a bill (SB139) to require insurers to cover a comprehensive list of infertility treatments, including IVF, bringing the number of states that now require some form of infertility coverage to sixteen and the number of states requiring coverage of fertility preservation services for those at risk of iatrogenic infertility to four. The new law becomes effective immediately.
The law requires all individual health insurance policies and contracts that are delivered, renewed, extended, or modified in the State by any health insurer, health service corporation, or health maintenance organization and that provide for medical or hospital expenses to also include coverage for fertility care services, including IVF. Individuals who suffer from a disease or condition that results in the inability to procreate or to carry a pregnancy to live birth are eligible. The benefits must be provided to covered individuals, covered spouses and covered non-spouse dependents, to the same extent as other pregnancy-related benefits.
With respect to IVF, the new law allows for six completed egg retrievals per lifetime, with unlimited embryo transfers in accordance with ASRM guidelines; single embryo transfer is encouraged when recommended and medically appropriate. The law indicates that no more than three cycles of ovulation induction or intrauterine inseminations may be required before IVF is covered, and that if IVF is medically necessary, prior cycles of ovulation induction or intrauterine inseminations are not required. Retrievals must be completed before age 45 and transfers must be completed before age 50.
Individuals who must undergo medically necessary treatment that may cause iatrogenic infertility are eligible for standard fertility preservation services, defined as those procedures consistent with ASRM and American Society for Clinical Oncology medical practices and guidelines.
The new law does not apply to self-insured health plans or to employer sponsored plans with fewer than 50 employees. Exclusions are also permitted for employers when the required coverage conflicts with the religious organization's bona fide religious beliefs and practices.