2005

DEFINITION OF INFERTILITY/PATIENT REQUIREMENTS

* Individual and group insurers are required to provide infertility coverage to individuals under 40 years old.
* Infertility means the condition of a presumably healthy individual who is unable to conceive or sustain a successful pregnancy during a one-year period.
* Limits coverage to individuals who have maintained coverage under a policy for at least 12 months.

Effective date – October 1, 2005

COVERAGE

* Lifetime maximum coverage of 4 cycles of ovulation induction.
* Lifetime maximum coverage of 3 cycles of intrauterine insemination.
* Lifetime maximum coverage of 2 cycles of IVF, GIFT, ZIFT or low tubal ovum transfer, with not more than 2 embryo implantations per cycle. Each fertilization or transfer is credited as one cycle towards the maximum.
* Limits coverage for IVF, GIFT, ZIFT and low tubal ovum transfer to individuals who have been unable to conceive or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures, unless the individual’s physician determines that those treatments are likely to be unsuccessful.

Requires infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.