IVF is mandated in MASS. All group products will pay for it.
Infertility Benefits
(Except a policy which provides supplemental coverage to Medicare or other governmental programs and
Dioceses)
______ According to M.G.L. c. 176G, § 4, policies “shall provide, to the same extent that benefits are
Provided for other pregnancy-related procedures, coverage for medically necessary expenses of
Diagnosis and treatment of infertility to persons residing within the commonwealth.. . [and]
‘infertility’ shall mean the condition of a presumably healthy individual who is unable to
Conceive or produce conception during a period of one year.” (See also Bulletin No. 95-08)
______
______
According to 211 CMR 37.05, “[s]ubject to any reasonable limitations as described in
211 CMR 37.08, insurers shall provide benefits for all non-experimental infertility procedures
Including, but not limited to:
(1) Artificial Insemination (AI);
(2) In Vitro Fertilization and Embryo Placement (IVF-EP);
(3) Gamete Intra fallopian Transfer (GIFT);
(4) Sperm, egg and/or inseminated egg procurement and processing, and banking of sperm or
Inseminated eggs, to the extent such costs are not covered by the donor's insurer, if any;
(5) Intracytoplasmic Sperm Injection (ICSI) for the treatment of male factor infertility;
(6) Zygote Intrafallopian Transfer (ZIFT).”
______ According to 211 CMR 37.06, “[I]nsurers shall not impose exclusions, limitations or other
Restrictions on coverage for infertility-related drugs that are different from those imposed on any
Other prescription drugs.”
______ According to 211 CMR 37.08(1), “[n]o insurer shall impose deductibles, copayments,
Managed Care: Health Maintenance Organization Ver. (053107) Page 23
Coinsurance, benefit maximums, waiting periods or any other limitations on coverage for
Required infertility benefits which are different from those imposed upon benefits for services
Not related to infertility.” Please confirm that the carrier complies with this requirement.
______ According to 211 CMR 37.08(2), “[n]o insurer shall impose pre-existing condition exclusions or
Pre-existing condition waiting periods on coverage for required infertility benefits. No insurer
Shall use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting
Or otherwise restricting the availability of coverage for required infertility benefits.”
Hormone Replacement Therapy and Contraceptive Services
(Except contracts purchased by a subscriber that is a church
|