In Rhode Island, insurers and HMO’s are required to cover expenses for diagnosing and treating infertility if they include coverage for pregnancy services in their policies. Infertility was originally defined as an “otherwise-healthy married individual” who was unable to get pregnant for at least a year. In 2007, this definition was modified to “a woman” who is unable to get pregnant for a year.
In addition, state lawmakers extended the age a woman can seek coverage for infertility treatment from 40 to 42. The state also limits the amount of a patient’s co-payment for fertility treatment to no more than 20 percent. In 2017, Rhode Island enacted a new law that now requires private insurers to cover “fertility preservation” treatment for people who have to undergo a medical procedure or treatment that may leave them infertile.
However, the state legislature also included a provision that allows insurance companies to impose a $100,000 cap on IVF treatment. This means if you have to undergo multiple IVF cycles, you could wind up hitting this cap and being denied further coverage over the $100,000 limit.
Want to improve Rhode Island’s 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?