Know your rights: The Illinois Infertility Mandate

illinois

The Illinois infertility mandate, enacted in 1991, requires group insurers and HMOs who provide pregnancy related benefits to also provide coverage for fertility treatments, including in vitro fertilization (IVF).

Further information is clarified in the Illinois Insurance Code which last updated in 1996. A summary of eligibility requirements, exemptions and services covered is outlined below.

How the mandate defines infertility

Illinois uses a conventional definition of infertility: “the inability to conceive after one year of unprotected sexual intercourse or the inability to sustain a successful pregnancy.”

Eligibility requirements

  • Patient must be covered by eligible plan and be unable to conceive after 12 months of unprotected intercourse.
  • IVF procedure must be performed at medical facilities that conform to the American College of Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization.

How the law treats male infertility

The law does not call out male infertility care specifically and male infertility services would be covered at the discretion of the insurer.

Services that are covered

Other fertility treatments may be covered at the discretion of the insurer, but the following services are explicitly listed in the mandate:

  • Diagnostic Tests
  • Artificial insemination
  • In vitro fertilization (IVF)
  • Uterine embryo lavage
  • Embryo transfer
  • Gamete intrafallopian tube transfer
  • Zygote intrafallopian tube transfer
  • Low tubal ovum

Limitations on coverage

A patient is limited to a lifetime maximum of 4 egg retrievals. If live birth occurs, patient becomes eligible for additional 2 egg retrievals for a second pregnancy.

Exemptions

The following organizations are exempt from providing coverage:

  • Employers with fewer than 25 employees
  • Religious organizations
  • Self-insured organizations

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 your out-of-pocket costs are likely to be.

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 possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).

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)

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.