Illinois Insurance Facts
Insurance Coverage for Infertility Treatment September 1997
Infertility is a condition that strikes hundreds of couples in
Illinois. Illinois law requires group insurance plans and health maintenance organizations (HMOs) to provide coverage for infertility. Here are the basic facts about the law. Who Must Offer the Coverage? The law requires insurance companies and
HMOs to provide coverage for infertility to employee groups of more than 25. The law does not apply to self insured employers or to trusts or contracts written outside Illinois.
Who is Covered? To receive infertility coverage, you must:
- live in Illinois
- have been unable to conceive after one year of unprotected sexual intercourse between a male and female
- have been unable to sustain a successful pregnancy
- not be voluntarily sterilized
What is Covered? Illinois requires group insurance and HMO plans to cover the diagnosis and
treatment of infertility the same as all other conditions. For example, they may not apply any unique copayments or deductibles for infertility coverage. Benefits must include coverage for:
- testing
- prescription drugs
- artificial insemination
- invitro fertilization (IVF)
- gamete intrafallopian tube transfer (GIFT)
- intracytoplasmic sperm injection (ICSI)
- donor sperm, eggs and embryo
What are the Limits? The maximum benefits available under the law are:
- four completed oocyte retrievals per lifetime of the individual
- two completed oocyte retrievals after a successful pregnancy is achieved as a result of an artificial reproductive transfer of oocytes
- one completed oocyte retrieval could result in many IVF, GIFT, ZIFT or ICSI procedures. There is no limit on the number of procedures.
What is Not Covered?
Your group insurance or HMO plan does not have to pay for:
- costs incurred for reversing a tubal ligation or vasectomy
- costs paid to a surrogate
- costs of preserving and storing sperm, eggs and embryos
- costs for an egg, sperm or embryo donor which are not medically necessary
- experimental treatments
- costs for procedures which violate the religious and moral teachings or beliefs of the insurance company or covered group
|
