Know your rights: The Arkansas Infertility Mandate

Arkansas

The Arkansas infertility mandate, enacted in 1987, requires at least $15,000 lifetime coverage for IVF (In Vitro Fertilization) treatment for infertility provided a woman’s eggs are fertilized by her husband’s sperm.

Further information is clarified in the Arkansas Insurance Department Final Rule on In Vitro Fertilization, which became effective in 1991. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

To qualify for treatment, you must have one of the following conditions:

  • Unexplained infertility for at least 2 years
  • Endometriosis
  • DES (In Utero to Diethylstilbestrol)
  • Blockage or removal of fallopian tubes (not including voluntary sterilization)
  • Male Infertility

Eligibility requirements

In addition to a diagnosis of infertility, as defined above, the law specifies the following additional requirements to qualify for treatment coverage:

  • Patient must be a policy holder or the spouse (and covered dependent) of the policy holder
  • Must be unsuccessful achieving pregnancy with less expensive treatment options covered by the plan, before attempting IVF
  • Eggs of patient must be fertilized by husband’s sperm
  • IVF procedure must be done at medical facility licensed or certified by Arkansas Department of Health, fertility clinics that conform to ACOG guidelines for IVF clinics or facilities that meet the American Fertility Society minimal standards for IVF programs

How the law treats male infertility

The Arkansas mandate has a mixed treatment of male infertility. On one hand, it calls out abnormal male parameters as a defined cause of infertility but on the other it requires female’s eggs to be fertilized by husband’s sperm. This should theoretically mean that sperm extraction procedures or other male fertility treatments should be included in coverage (though they are not specifically called out by the law) but treatments using donor sperm would not be.

Services that are covered

  • Lower cost infertility services including diagnosis & treatment at the discretion of the insurer
  • In Vitro Fertilization (IVF)
  • Cryopreservation (freezing embryos) for future implantation

Limitations on coverage

  • $15,000 lifetime benefit for all fertility services
  • Benefits are subject to same deductibles, co-insurance, and out-of-pocket maximums that apply to the plan’s maternity benefits
  • You must follow your plans guidelines for fertility treatment which may include going through less expensive treatment options before trying IVF
  • 3rd party reproduction: donor sperm, donor eggs or surrogacy are not covered.

Exemptions

The following organizations are exempt from providing coverage:

  • HMO plans do not need to cover fertility treatments
  • Self-Insured employers (including Wal-mart, Tyson foods, JB Hunt Transport and Murphy Oil)

Tips & Resources

Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.

Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what is covered and what isn’t. Since certain types of health insurance plans are exempt from the mandate, it is important to know what type of plan you have and if it is eligible to cover fertility treatments.

Learn what things cost: Knowing costs associated with different tests and fertility treatments allows you to plan. You can get a general idea of cost range through internet research, but you should call your physician to get specifics as prices vary by practice. Some practices may hesitate to provide costs up front not knowing what you will need. It may help to ask for costs of specific tests or treatments or to schedule an appointment with the practice financial coordinator if they have one.

Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as you can will not only improve your overall fertility but can help you qualify for additional resources.

Talk to a financial counselor: Many fertility clinics have a financial counselor on-staff who is available to work with patients to develop a plan that enables them to afford fertility care. The financial counselor may be able to help you figure out what costs you are likely to incur, determine if any of the expenses are able to be billed, negotiate a payment plan, get discounts or apply for financial assistance.

Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with others in your area in our local forums.

References:


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.