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Who is covered by Colorado’s new IVF insurance requirement?

Starting in January, some Colorado residents’ health insurance will pay for in vitro fertilization, but like many state efforts to expand coverage, that doesn’t apply to everyone.

House Bill 1008, passed this spring, requires employer health plans for large state-regulated groups to cover the full range of infertility treatment services. People with other types of health insurance may have some coverage, but are more likely to run into limits.

Here are answers to some common questions about the new law:

How will I know if this applies to me?

First, check your insurance card. If it says “CO-DOI” somewhere on the card, your insurance plan is state regulated. Otherwise, the new mandate does not apply to you. This was also the case for other coverage requirements set by the state in recent years, such as the cap on out-of-pocket expenses for insulin.

However, only large group plans regulated by the Colorado Division of Insurance fall under the new mandate. You can’t tell by looking at the map whether your insurance plan is large group or small group, so you’ll need to call your employer’s human resources department or insurance company to be sure.

Religious organizations are allowed to ask their insurance plans not to cover certain fertility services they object to, but are required to notify employees if they do.

If you are covered by Medicaid or another form of government-provided insurance, the mandate does not apply to you.

I’m covered. What does that mean?

Beginning in January, you have coverage for fertility services deemed appropriate under the guidelines of the American Society of Reproductive Medicine. This can include preventive services, such as egg freezing before a woman undergoes cancer treatment.

For people who need in vitro fertilization, the insurance will have to cover three egg retrievals and unlimited embryo transfer attempts. IVF involves stimulating the ovaries with drugs to produce more eggs, which are retrieved and fertilized outside the body with sperm from a partner or donor. They are then transferred into the body, which will hopefully result in a healthy pregnancy and birth.

Plans aren’t allowed to place restrictions on drugs used for infertility beyond what they have for other drugs, and can’t set a separate deductible or require higher out-of-pocket payments. This still leaves room for variation, however: a household with a high-deductible insurance plan will almost certainly pay more for infertility care than a household that pays higher monthly premiums in exchange for lower costs when he uses care.

The mandate uses the definition of infertility from the American College of Obstetricians and Gynecologists, which is an inability to conceive after one year of regular intercourse without contraception for women under 35 and six months without success for women older. It also allows coverage if a doctor diagnoses infertility another way.

My plan is not under the warrant. Do I have coverage?

Certain infertility services have been considered an essential health benefit in Colorado since 2017. This means that individual and small group plans must cover testing to diagnose infertility, as well as artificial insemination, without barriers or additional costs.

They don’t have to cover IVF or egg freezing to prevent infertility. It’s not common, but some companies choose to add additional infertility coverage, so check with your insurer before starting treatment.

You may have additional coverage at some point in the future, if the US Department of Health and Human Services approves.

Why do only certain plans require federal approval?

denverpost

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