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Maternity Insurance Illinois Question & Answers

2014 April 3
by Sarah Fields

Jenny asks…

whats the deal with maternity leave?? I work in indiana but i live in illinois?

Is there any way to get some kind of compensation during my time off?

Sarah Fields answers:

The only answer is to check your employer’s benefits package. Where you live has nothing to do with it. The Federal Government requires that an employer give you at least 6 weeks off without losing your job, but does not mandate that the time be paid. Generally, if you are paid, it is under disability insurance.

Daniel asks…

Does anyone know of any insurance companies in CT that covers the IVF procedure?

Sarah Fields answers:

In 1987, Massachusetts became the first state in the country to pass a law that legally defined infertility as a medical condition and mandated that health insurance companies provide coverage for infertility treatment. Today it is one of only 15 states that mandates coverage for infertility issues. Infertility is covered 100% in Massachusetts. We also have the highest number of twin births in the country. So for me, my infertility coverage was covered 100%. I paid occassional co-payments when necessary.

States with a “Mandate to Cover”

What does a “Mandate to Cover” mean? It’s a law that requires insurance carriers to provide a certain kind of benefit. In this case, insurers in the following states must provide some level of fertility treatment benefit in every policy and include the cost in the policy premium. See the specific states below for details and limitations.

For more information about any of the mandates listed here (and to determine if your state has recently changed or enacted an infertility insurance mandate), you should contact your state’s Department of Health or Department of Insurance.

Arkansas
Mandates insurance carriers that provide maternity–related benefits to cover IVF. Allows insurers to impose a lifetime benefit cap of $15,000. Health maintenance organizations are exempt from the law.

Hawaii
Mandates insurance carriers that provide pregnancy–related benefits to cover one cycle of IVF, only after several conditions have been met.

Illinois
Mandates insurance carriers that provide pregnancy–related benefits to cover the diagnosis and treatment of infertility, including various ART procedures, but limits first-time attempts to four complete oocyte (egg) retrievals, and second births to two complete oocyte retrievals. Insurance carriers are not required to provide this benefit to businesses (group policies) of 25 or fewer employees.

Louisiana
Mandates insurance carriers to cover the “diagnosis and treatment of correctable medical conditions.” Thus, insurers may not deny coverage for treatment of a correctable medical condition to someone solely because the condition results in infertility. Coverage is not required for fertility drugs; in vitro fertilization or any other assisted reproductive technique; or reversal of tubal ligation, a vasectomy, or any other method of sterilization.

Maryland
Mandates insurance carriers that provide pregnancy–related benefits to cover IVF after a two–year wait following diagnosis, with no wait required for certain diagnoses. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees. Religious organizations can choose not to provide coverage based on their religious views. A carrier may limit IVF benefits to three attempts per live birth, not to exceed a lifetime maximum benefit of $100,000.

Montana
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a basic health care service. The law does not define “infertility services”, and some HMOs exclude IVF.

New Jersey
Mandates insurance carriers that provide pregnancy–related benefits to cover comprehensive diagnosis and treatment of infertility, including assisted reproductive technology procedures, but limits attempts to four complete oocyte (egg) retrievals per lifetime. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees.

New York
Mandates coverage for the diagnosis and treatment of correctable medical conditions. Requires coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. Certain procedures are excluded, including IVF, GIFT, reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include prescription coverage must cover drugs approved by FDA for use in diagnosis and treatment of infertility (including Ovulation Induction (OI)). The law does not apply to HMOs.

Ohio
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a “preventative” benefit. The treatment must be “medically necessary,” and the Ohio Department of Insurance has ruled that GIFT, ZIFT and IVF are not medically necessary.

Rhode Island
Requires insurers and HMOs that provide pregnancy–related benefits to cover the cost of medically necessary expenses of diagnosis and treatment of infertility. The law defines infertility as “the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year.” The patient’s co-payment cannot exceed 20 percent.

West Virginia
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a preventative benefit. The law does not define “infertility treatment” and HMOs have interpreted the term as excluding IVF.

States with a “Mandate to

James asks…

I have this illinois healthy women pink card?

does this include fertility treatments.im trying to conceive

Sarah Fields answers:

It might – I am not familiar with it specifically.

Illinois is one of the 15 states that mandate group insurers and HMOs provide coverage for fertility diagnosis and treatment if they are offering maternity benefits.

Http://www.resolve.org/site/PageServer?pagename=lrn_ic_stintro#Illinois

Contact Fertility Lifelines toll free at 1-866-LETS TRY. Give them all the info off your card / all of your insurance info and they will do a free analysis explaining what is and is not covered.

Http://www.fertilitylifelines.com/payingfortreatment/insurancecoverage.jsp

If your pink card does not cover it, go to your employer or your husband’s and look at getting onto their insurance plan.

Good luck!

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