Eleven states currently require insurance companies to cover treatments for infertility. But if a group of state lawmakers has its way, New Hampshire could become the twelfth. Under pending legislation in the New Hampshire House, couples seeking treatment for infertility would have the option to purchase coverage and insurers would be required to include it.

Insuring Infertile Couples
One of the measure's co-sponsors, James Pilliod, MD, is a practicing New Hampshire pediatrician. He says an infertility diagnosis can be devastating for a couple, and insurers should help foot the cost for a treatment that could help produce a life. "I believe that the consequences of apparent infertility can be so devastating that it becomes a health hazard or possibly mental health problem," Pilliod told Priority Healthcare.

"There is reason to expect a so-called Health Insurer to cover at least a substantial part of the cost as they would do for many behavioral health services and medical needs," he said, in an interview.

However, the bill would prevent couples from seeking IVF treatment—at least initially. "Less costly measures should be required before IVF or other procedures are attempted or advised," Pilliod said.

The insurance industry is opposed to the bill, claiming that mandated fertility treatment coverage would simply increase premiums across the board. The proposed legislation is currently being considered by the state House Commerce Committee. If approved by the panel, it could then move to the House floor for a full vote.

How Other States Mandate Coverage
This required coverage is known in legal circles as a "mandate to cover". States that currently have such a mandate on the books include Arkansas, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia.

There are exceptions to the laws in these states. For instance, companies that self-insure are exempt from such mandated coverage. Here's how the individual statutes are broken down by state:

• Arkansas requires all health insurance companies that cover maternity benefits to cover the cost of in vitro fertilization (IVF), as long as patients meet certain conditions, but HMOs are exempt.
• Hawaii mandates certain insurance plans to provide a one-time-only benefit for outpatient costs associated with IVF, as long as patients meet certain conditions.
• Illinois requires insurance policies that cover more than 25 people and provide pregnancy-related benefits to cover the costs of infertility diagnosis and treatment.
• Maryland mandates coverage for outpatient costs of IVF for health and hospital insurance policies that also provide pregnancy-related benefits.
• Massachusetts requires HMOs and insurance companies that cover pregnancy-related services to further cover expenses associated with infertility diagnosis and treatment. Coverage for experimental procedures, surrogacy, reversal of voluntary sterilization, or egg freezing is optional.
• Montana mandates HMOs to cover infertility services as part of basic preventive health care services. But the law specifically excludes infertility treatment coverage for health insurers that are not HMOs.
• In New Jersey, policies that cover a minimum of 50 people and pregnancy-related services must also cover the cost of infertility diagnosis and treatment. The law allows religious organizations to request an exclusion of this type of coverage, however, if it violates the organization's practices and beliefs.
• New York State requires health insurance companies to cover the diagnosis and treatment of "correctable medical conditions", which it states includes infertility. Procedures like reversal of voluntary sterilization or procedures aimed at solely producing a pregnancy, such as IVF, are not covered.
• Ohio mandates that HMOs include infertility treatment in their coverage of basic preventive health services. But treatments deemed as experimental are not included.
• In Rhode Island, insurance companies and HMOs that already cover pregnancy-related benefits must further cover the cost of "medically necessary expenses related to the diagnosis and treatment of infertility.
• West Virginia mandates that HMOs which cover basic health care services must also cover infertility treatment when medically necessary.¹

Whether New Hampshire might wind up being added to this list is still uncertain. A measure similar to the one now being considered was approved by the New Hampshire Senate in 1999, but it was subsequently killed in the House. Pilliod says he is doubtful of the bill's passage this year, as well.

1. The Fertility Neighborhood. States That Require Insurers to Cover Infertility. Available at:  http://www.fertilityneighborhood.com/content/financing_your_care/
state_mandated_coverage_428.aspx. Accessed February 15, 2005.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.