States mandating infertility insurance coverage

For decades, states have set rules for health coverage through mandates, laws that require insurers to cover specific types of medical care or services.

The health law contains provisions aimed at curbing this piecemeal approach to coverage.

Fifteen states have enacted legislation requiring private insurers to cover some or all of the costs of infertility treatments.

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States, however, continue to pass new mandates, but with a twist: Now they’re adding language to sidestep the health law, making it tougher than ever for consumers to know whether they’re covered or not. They may require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care.

Some mandates require that certain types of providers’ services be covered, such as chiropractors.

Each patient should research his or her plan extensively in advance of making an appointment, either online or by calling the insurer or benefits representative, or both.

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To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces.