The WINFertility Quality Discount Treatment Program is designed for patients with no infertility insurance coverage and for those who have exhausted their IVF insurance benefit. However, patients should investigate their medical insurance policies and utilize whatever medical and pharmacy benefits are available to them. Some diagnostic tests, corrective surgeries and some medications may be covered, even though more advanced treatments are not. Below is some helpful information about insurance options.
State-Mandated Infertility Insurance Coverage
Currently, 15 states have laws that require some insurers to either cover fertility treatment (must pay for the coverage) or ‘offer’ coverage (must only let its subscribers know that there are IVF insurance coverage options available, but are not required to pay for it). The Mandated States include: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.
Exceptions, Requirements and Limitations
Some of the mandated states offer plans that exclude IVF, several cover only IUI treatments and surgical interventions. The plans may also have various limitations on number of treatments, age and by whom and where treatments may be performed.
Living in a mandated state does not guarantee that you will have IVF insurance coverage. Employers who buy insured benefits through an insurance company must comply with the state mandated law. However, if your employer is ‘self-insured’ and has a self-funded benefits program, your employer is exempt from state mandates.
RESOLVE, the national infertility association, has a comprehensive overview on IVF insurance that is an excellent resource.
Other Insurance Plans
Many other insurance plans provide some coverage for infertility diagnosis, treatment and even medication coverage, either under the medical provision or under the pharmacy benefit. It is important to find out what, specifically, your plan covers and whether your physician is a provider for the plan. Each plan also has their own rules and guidelines, including type of provider, types, numbers and order of tests, as well medications and pharmacies recognized. The language may be confusing, but it is to your benefit to learn the details prior to seeking treatment so that you can make the most informed decisions regarding your care.
To learn more about WINFertility Patient Financing, please click here.