The Debate Marches On:

Should Infertility Coverage Be Considered an “Essential” Health Benefit?

Article sponsored by New Life Agency

In a perfect world, the tens of thousands of women and men suffering from infertility who consult reproductive specialists every year would know that their medical treatment would be covered by their health insurance. Infertility is, after all, considered a disease as stated by the World Health Organization. 

Yet the establishment of an “Essential Health Benefits” package as outlined in the Affordable Care Act will most likely not provide for universal insurance coverage for the diagnosis and treatment of infertility.

Dealing with out-of-pocket costs

When the first “test tube” baby was born in 1978, so was a new medical specialty. Unlike diseases that require treatment in order to maintain quality of life, or life itself, some argue that in vitro fertilization (IVF) is not a medical necessity; no one “needs” to have a child in order to live, right? But yet more and more people are accessing IVF to build their family:

• 10% of U.S. women of child-bearing age have consulted a doctor for infertility issues.
• In 1996, there were 64,681 IVF procedures reported to the CDC. In 2009, there were 146,244 – an increase of over 226%.
• In 2009, 106,060 live-birth deliveries and infants born in the U.S. as a result of assisted reproductive technologies (ART), such as IVF.

So why don’t insurance companies cover IVF? The truth is, if an insurance company is “for profit” – like all companies – they need to be profitable in order to survive. They have a responsibility to their shareholders. Those profits are determined by the difference between what they collect in premiums and what they pay out in claims – taking into account sales, marketing, underwriting and administrative costs. Some insurance companies view IVF as a “high-risk” benefit and given the fact that many do not see it as a medical necessity, it is easy for them to make the case not to cover IVF.  

So it’s really no surprise that, outside of the limited mandated states and a few group plans, traditional medical insurers have decidedly avoided offering infertility coverage. 
 
So what are your options if your health insurance does not cover IVF? Fortunately, there are a variety of alternatives and some actions you can follow to take control of the financing of your family building.

• You might be able to get Assisted Reproduction Insurance added on to your employer’s group insurance plan. Your employer (your insurance company’s customer) makes the decision on whether or not your insurer offers Assisted Reproduction Insurance. Tell your Human Resources Department to ask your group’s insurer about adding this coverage to your plan as an insurance rider.
• Tell your Human Resources Department to offer Assisted Reproduction Insurance as a Voluntary Benefit. Your employer may pay for Voluntary Benefits or you as the employee may pay out of pocket on your own for the Voluntary Benefit.
• Assisted Reproduction Insurance can be offered through a supplemental insurance program filling the gap of traditional insurance coverage. Anyone can apply for supplemental insurance regardless of your employer or insurance plan. To find out about plans that might work for you, search Assisted Reproduction Insurance or IVF insurance on the Internet.
• Talk to your fertility doctor, nurse, or the clinic staff about financing programs that might be offered through the clinic.  Ask about special loans that are only for IVF insurance.  Your doctor is there to help you and it’s important that you are open with them about the cost and your ability to pay for the treatment and medications.
• Ask your doctor if they know of any special programs to help you pay for the medication.

What IS Essential is a Solution

For those of us facing infertility, the dream of building a family is “essential.” Ask any couple with a happy, healthy family if their children are “essential” to their life. RESOLVE is fighting tirelessly to create awareness – and action – that will give men and women struggling with infertility the insurance coverage that will make their dream an affordable reality. Until such time, the patient community needs as many options as possible. The good news is that there are viable solutions already in place for patients, solutions that provide hope. And that is essential.

Brought to you by: