Insurance coverage for infertility and IVF

My dh, owns a company with a branch in NJ, two of his employees did IVF. My dh informed me that they were thrilled because in the past, they couldn't afford all the IVF cycles. His business has more than 50 employees, but that's how I found about the NJ mandate. If you check the link below, it explains each state, and what they allow etc. If you live in New Jersey and your insurance doesn't pay, I believe you can buy a "rider" or whatever they are called (not good with insurance lingo) to cover infertility. They say that the employer can choose not to have it be part of the "plan" if you have less than 50 employees. I know that my dh's company uses Oxford, and it covers it. He has a plan where you don't need referrals either.


The more I am reading about this, the more it's my understanding, that it HAS to be included.


http://www.resolve.org/main/national/advocacy/insurance/facts/history.jsp?name=advocacy&tag=insurance

http://www.cga.ct.gov/2005/rpt/2005-R-0236.htm

Message edited 10/11/2005 4:40:34 PM.

Re: Insurance coverage for infertility and IVF

After some research....I found that for me and the company I work for, that this is not true. I live and work in NJ. I called both my benefits department and my insurance company. Here's what I was told:

My company has a self insured type of medical plan. That means that they select the carrier and they can select the plan design, and they set up a fund to pay the claims directly. This is in leiu of a Fully Insured plan (some HMO's and POS plans) where the company purchases the plan based on the plan designs offered by each insurer, and they pay a set rate per head for coverage- and the company does not worry about paying the actual cost of claims, the insurance company covers that cost in the premium they charge.

So...apparently there are loop-holes to get around the state mandate. Since my company is a self-insured plan, it does not need to provide the state mandated levels of coverage. I have contacted my attorney (who is my brother ) to see if there is anything I can do to get around the loop-hole as my company has gotten around the state mandate. Not sure there is any hope though.

Sorry so long....

Re: Insurance coverage for infertility and IVF

I believe NY has the mandatory IUI coverage but my company is self insured also and does not even provide IUI benefits so all of my cycling is out of pocket. I could go on DH's plan in May '06 (open enrollment) and be covered for IUI but it would cost us an extra $822/month. To spend that for coverage for IUI only does not seem like a savings to me.

It's just not right that these insurance companies get away with this.

Message edited 10/11/2005 8:35:56 PM.

Re: Insurance coverage for infertility and IVF

Yes, that is true. If the company is self-insured they choose what they cover and don't cover.

However, NYS has a mandate for people who have insurance they have some options.

Re: Insurance coverage for infertility and IVF

I was speaking to my dh, and he explained to me that if a company is 'national' they don't have to necessarily follow the state mandates, because then each state would have different policies :(. He said that falls under the ESLA act (not sure if I have the right acronym).

Bottom line, this has to change...it's so emotionally and physically stressful, to make this financially draining as well, is just horrible :(

Re: Insurance coverage for infertility and IVF

I have Anthem Blue Cross/Blue Shield and they only cover me up until I'm diagnosed with Infertility. They will cover drs. visits, blood work, HSG, etc but the minute you do IUI, IVF coverage is over, along with prescription coverage!!

In two days I've spent $1100 on my IVF meds

Re: Insurance coverage for infertility and IVF

Kat,
Whats to stop you from doing that for 2 months or so to get your IVF then canceling you off of his policy. Yes it will cost you more at first but only while you are going through the process

Re: Insurance coverage for infertility and IVF

Melijane,

I thought about going on his plan for a few months but I would have to wait until May '06. Plus I will only be covered for IUI - not IVF so I don't think it's really worth it since you can do an IUI cycle for about $1,000 with limited monitoring.

Very frustrating