| California is one of 15 states that currently has some | | | | Now, this does not mean that you cannot have IVF, |
| form of infertility insurance mandate, and knowing | | | | it just means that the insurance policy is not required |
| what it does and does not offer state residents is | | | | to cover the cost of the actual fertilization of the |
| very important if you find yourself dealing with | | | | egg "in vitro". If your doctor or fertility clinic will break |
| infertility. | | | | down the cost for services associated with IVF, you |
| According to California's Health and Safety Code | | | | would have to pay for the "fertilization" outside of |
| 1374.55 "(a) On and after January 1, 1990, every | | | | the womb yourself. You may also be able to provide |
| health care service plan contract which is issued, | | | | a case for needing to have IVF done versus GIFT if |
| amended, or renewed that covers hospital, medical, | | | | both of your fallopian tubes are completely blocked |
| or surgical expenses on a group basis, where the plan | | | | and cannot be cleared with any medical or surgical |
| is not a health maintenance organization as defined in | | | | treatment. Obviously, under these circumstances IVF |
| Section 1373.10, shall offer coverage for the | | | | would become "medically necessary" and GIFT would |
| treatment of infertility, except in vitro fertilization, | | | | not be a viable treatment option for you. |
| under those terms and conditions as may be agreed | | | | This does not mean that your insurance company will |
| upon between the group subscriber and the plan. | | | | or even has to cover IVF, but that you should |
| Every plan shall communicate the availability of that | | | | examine all options and discuss all possibilities for |
| coverage to all group contract holders and to all | | | | treatment with your insurance company. If your |
| prospective group contract holders with whom they | | | | insurance company is willing to cover all costs except |
| are negotiating." | | | | for the fertilization of the egg outside of the womb, |
| As long as you do not have an HMO plan and work | | | | your out of pocket expense for having IVF to treat |
| for a company that employs fewer than 20 | | | | your infertility will be greatly reduced to about $2000 |
| individuals, do not work for a religious organization, | | | | plus any deductible and normal out of pocket costs. |
| and your health care plan is not "self-insured", | | | | Bottom line is that though your employer is not |
| infertility diagnosis and treatment (except for IVF) | | | | required to purchase the insurance that offers |
| should be offered in a health care plan to your | | | | infertility coverage, the insurance companies are |
| employer. Even though IVF, or in vitro fertilization is | | | | required to offer it as an option. If your plan |
| not included in the coverage mandate, the diagnosis, | | | | currently does not include any infertility coverage, |
| diagnostic testing, medication, surgery, and GIFT or | | | | talk with the human resources manager or benefits |
| gamete intrafallopian transfer is included and must be | | | | manager to see if it is possible to have your |
| covered in any plan that includes infertility coverage. | | | | company offer more than one plan to all employees. |