In a victory for couples undergoing infertility treatment, the state of Connecticut has approved legislation mandating infertility insurance coverage. Effective October 1, the new law was approved overwhelmingly in both houses of the Connecticut legislature.

Expanding Treatment Access
The measure will now require most individual and group health insurance policies in that state to cover the cost of the diagnosis and treatment of infertility, including in vitro fertilization (IVF), and other similar assisted reproductive procedures.

"According to our calculations, it will open coverage to about 70,000 to 75,000 infertile couples who may not have been able to access care previously for lack of health insurance," explained Joseph Isaacs, CAE, President and CEO of RESOLVE: The National Infertility Association, which lobbied for the new legislation. 

RESOLVE is a patient advocacy organization aimed at promoting reproductive health and equal access to family-building options for men and women diagnosed with infertility or other reproductive disorders. The organization also provides education and patient support services.
 
A Long Campaign
"In Connecticut, a number of key legislators, medical professionals, and RESOLVE volunteers worked tirelessly to advance this important legislation," Isaacs stated. "Thankfully, after several years of diligent advocacy, their collective voice was heard."

Along with some of its local chapters in Connecticut, RESOLVE had stepped up its lobbying for the legislation in the past five years, Isaacs explained. That included letter-writing campaigns, legislative visits, and testimony before legislative committees. "Clearly, we are proud of the role we've played," he said. "I can't say enough about the local-level volunteers and the grassroots advocacy being displayed. It really made the difference."

A Change in Connecticut's Law
Connecticut becomes the 12th state in the country to require such coverage, behind Arkansas, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia. Connecticut formerly had a "mandate to offer" on its books, meaning the statute required insurers to advise employers that infertility coverage is available, but didn't stipulate that those insurers provide the coverage. That changed with the new law.

Connecticut's new "mandate to cover", along with the eleven other states that passed it, means policies automatically include the cost of infertility treatment coverage. It now leaves only two states with "mandates to offer": California and Texas.

Companies that self-insure, however, are exempt from state regulation.

Coverage Limits Included
Under the new legislation, insurance coverage will be provided for four cycles of ovulation induction, three cycles of intrauterine insemination (IUI), and two cycles of IVF, with no more than two embryos implanted per cycle. Coverage is also limited to individuals who have maintained coverage under their policy for at least one year.

RESOLVE plans to continue lobbying in Connecticut to ease some of these restrictions, which is similar to other states. For example, New York and New Jersey have age limits attached to their coverage laws. Women over age 44 automatically lose such coverage. In Connecticut, the age limit is 40.

That's due to the reduced odds of achieving a pregnancy as women age. According to the American Society for Reproductive Medicine (ASRM),¹ a full one-third of couples in which the female partner is at least age 35 will face infertility problems. By the time a woman reaches age 40, it's estimated that two-thirds will fail to achieve pregnancy spontaneously.

However, the group believes "age" is a topic best left to women and their doctors, and plans to lobby against the age restriction early next year when lawmakers re-convene.

Other States May Follow Suit
Several other states are now considering following suit with Connecticut, including Florida and Pennsylvania, Isaacs said.  Several bills on infertility treatment coverage are also pending on Capitol Hill.

RESOLVE is actively campaigning for such coverage in Pennsylvania, Isaacs told Priority Healthcare. The organization is also eyeing California, where, like in Texas, laws only require insurers to offer infertility coverage. RESOLVE hopes it can convince California lawmakers to take the additional step, explained Isaacs. He says he believes they may be open to the idea "based on their openness to passing stem cell research legislation."

Federal Possibility?
Meanwhile, Isaacs says convincing legislators of a federal law mandating fertility coverage would be "a long haul". "Clearly, the federal government is looking at other appropriations needs," he said. However, RESOLVE continues to push for expanded coverage by HMOs under the federal employee health benefits program, as well as expanded coverage for military families, said Isaacs.

He says a pending report from the Centers for Disease Control and Prevention (CDC) is expected to show the numbers of infertile couples in the United States continues to climb. "RESOLVE hopes to be very vocal in the future with regard to recognizing [infertility] as a disease, and ensuring that it is treated under our medical insurance system, as other diseases are," Isaacs said.

1. American Society for Reproductive Medicine (ASRM). Prediction of Fertility Potential in Older Female Patients. Available at: http://www.asrm.org/Patients/FactSheets/Older_Female-Fact.pdf. Accessed September 27, 2005.

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