re:
Heather, Quick Question About Coverage??
message #:
7919.2 in response to 7919.1
Karen,
So far this is what I have found:
Maryland
The Maryland law requires health and hospital insurance policies that provide pregnancy-related benefits to also cover the outpatient costs of in-vitro fertilization. Policies that must provide the coverage include those covering people who live and work in the state, regardless of whether the policy is issued inside or outside the state. HMO's must provide IVF benefits to the same extent as the benefits provided for other infertility services.
Patients need to meet the following conditions in order to get their IVF covered:
* The patient's eggs must be fertilized with her spouse's sperm;
* The patient is unable to get pregnant through less expensive covered treatments;
* The IVF is performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
* The patient and his or her spouse must have at least a two-year history of infertility; OR their infertility must be associated with one or more of the following conditions:
o Endometriosis;
o Fetal exposure to diethylstilbestrol, also known as DES;
o Blocked or surgically removed fallopian tubes; or
o Abnormal male factors, including oligozoospermia.
Coverage may be limited to three in vitro fertilization attempts per live birth and a maximum lifetime benefit of $100,000.
A religious organization may, by request have this coverage excluded from its policies and contracts if the required coverage conflicts with its bona fide religious beliefs and practices.
Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide the IVF coverage. (Maryland Insurance Article §15-810, Health General Article §19-706).
>> It is going to vary between insurance companies as to what hoops you will have to jump through to get treatment, but having a history already with a proven treatment should help.
