Lawmakers in Arkansas passed a fertility mandate that requires certain insurance policies to cover In Vitro Fertilization (IVF) treatment for infertility. However, Arkansas’ fertility mandate is akin to a piece of swiss cheese (i.e. there are many holes). First, insurance companies doing business in Arkansas are only required to cover up to $15,000 for IVF treatment. This is a lifetime cap, which means that once the $15,000 limit is reached, the insurance company is off the hook for any cost over and above the cap.
Second, health maintenance organization (HMO) insurance policies are exempt from the fertility mandate. This means if you have an HMO insurance policy, your insurance provider has the option to provide or deny coverage for fertility treatment. The same exemption is afforded to insurance policies offered through Arkansas’ high risk pool (the Arkansas Comprehensive Health Insurance Pool).
Along with the loopholes described above, there are a number of prerequisites you and your partner need to meet in order to trigger the mandate. For example, you and your partner need to be able to show your insurance company that you’ve struggled with infertility for at least two years or the fertility issue is related to (i) endometriosis; (ii) abnormal male factors, (iii) blocked or removed fallopian tubes, or (iv) exposure to diethylstilbestrol. In addition, you and your partner need to show that you have not been able to get pregnant through a less-costly form of infertility treatment, such as IUI.
Want to improve Arkansas’ fertility coverage mandates? Contact RESOLVE and ask how to help lobby for coverage in your area. You never know.
Do insurance companies have to cover IVF?
Yes, with numerous exceptions.