The Ohio infertility mandate requires health maintenance organizations (HMOs) to provide basic health services, which includes infertility care, when medically necessary. A bulletin released by the department of insurance clarifies that IVF and other forms of assisted reproduction are outside of the scope of the law.
Further information is clarified in Ohio Chapter 1751 of the Ohio Revised Code Annotated. A summary of eligibility requirements, exemptions and services covered is outlined below.
How the mandate defines infertility
The Ohio mandate does not provide a definition of infertility. However, it does define infertility services at “diagnostic and exploratory procedures to correct medically diagnosed diseases of the reproductive organs, including but not limited to: Endometriosis, Clogged or collapsed Fallopian tubes, and Testicular failure.”
Plan requirements: The mandate extends only to HMO but not other forms of health insurance.
Service Requirements: There is a focus on “medically necessary” procedures
How the law treats male infertility
The Ohio Mandate provides testicular failure as an example for a condition that should be treated under the law. This means that there is a legal recognition of male infertility. The “medically necessary” language may favor treatment of conditions that cause male infertility.
Services that are covered
Diagnostic testing and exploratory and corrective procedures aimed at repairing function of reproductive organs.
Limitations on coverage
There aren’t clearly defined exemptions listed in the law, however bulletins provide clarifying language that IVF and assisted reproduction is outside the scope of the law.
The following are exempt from providing coverage:
- Other forms of insurance outside of HMO plans
- Self insured employers
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). You may also be able to connect with other people in your area via our local forum boards.
- Fertility Authority: Ohio infertility mandate
- Resolve: Insurance coverage by State
- National Conference of State Legislatures: State Laws related to insurance coverage for infertility treatment
- Ohio Revised Code Annotated: Section 1751
- Ohio Department of Insurance: Bulletin 2009-07