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What to Know about Infertility Insurance Coverage

(image):  Infertility Insurance Coverage By State and Scorecard Map from RESOLVE, a 501(c)3 nonprofit dedicated to ensuring that all people challenged in their family building journey reach resolution. Click HERE to learn more.

Even as a growing number of states require certain insurers to offer infertility insurance coverage, the details of who is required to provide coverage, who is eligible for coverage and what fertility treatments are covered vary widely from employer to employer and state to state.

As we have written, the U.S. Affordable Care Act left it up to each state to define the Essential Health Benefits (EHB) that insurers are required to cover. Consequently, ACA insurers may no longer cover some fertility treatments that were previously covered by state law.

For example, in April 2020, the state of New York passed a measure requiring insurance policies covering employee groups of 100 or larger to include coverage of in vitro fertilization, becoming the tenth state to require IVF coverage. The new law also includes expanded coverage for fertility-preservation efforts, such as egg or sperm freezing, for patients who require lifesaving but invasive medical treatments, such as radiation therapy, that may result in infertility.

California, in contrast, has for many years required insurers covering at least 20 employees to offer infertility treatment insurance, usually for a higher premium. In 2013 lawmakers passed legislation to clarify that the infertility insurance mandate covers LGBTQ intended parents.

In October 2019, the American Society for Reproductive Medicine (ASRM) reported on the results of Massachusetts’s infertility insurance mandate, considered the most longstanding and comprehensive in the country. Their conclusion? With exemptions for large, self-insured employers and public health insurance policies, only 36 percent of reproductive-age women in Massachusetts are covered by the mandate.

The National Conference of State Legislatures offers this state-by-state summary of infertility insurance coverage nationwide, citing the pertinent statutes.

Infertility Insurance Coverage Can Be Difference on Affordability

As we reported in 2014, for most intended parents considering assisted reproductive technology such as egg donation or sperm donation, in vitro fertilization (IVF) or surrogacy, the cost of ART

procedures is a serious consideration.

This dearth of infertility coverage leaves many infertile couples, to say nothing of single or same-sex intended parents, with a terrible choice. A single round of in vitro fertilization, in which an egg is fertilized with sperm outside of the womb, in a lab, can cost between $15,000 and $25,000; a single egg donation cycle is an additional $18,000 to $20,000.

Financially strapped intended parents whose health insurance does not cover IVF and egg donation costs too often feel pressure to maximize the odds of a successful pregnancy by having more than one embryo implanted—they simply cannot afford to come back for a second or third round.

Insurance coverage for even a portion of the cost of these highly specialized procedures can, for some intended parents, mean the difference between proceeding or not.

Intended parents should address questions about financing and insurance coverage directly with the donor or surrogacy agencies they are working with, as well as with their reproductive medical provider. An experienced fertility attorney also can provide referrals to insurance experts who specialize in ART and fertility insurance coverage.

Donor, Surrogacy Agreements Document Insurance Coverage

At IFLG, a New York surrogacy lawyer also will work with intended parents, surrogates and/or donors to draft surrogacy agreements customized to each individual situation. Generally, if a surrogate has medical insurance through her or a spouse’s employer, her insurance will cover basic healthcare and prenatal care during the course of the pregnancy. Typically, intended parents, or their insurer, are responsible for all costs of egg donor cycles and insemination procedures, as well as any medical costs resulting from pregnancy complications or delivery. The surrogacy agreement will establish each party’s responsibilities in each situation.

Since we launched IFLG to practice exclusively in fertility and the laws surrounding assisted reproductive technology, the trend has been toward expanding infertility insurance coverage, making ART more accessible for thousands of Americans. Just as laws governing parentage and assisted reproduction are a patchwork across the United States, so are laws mandating coverage for infertility treatment. For intended parents considering family-building with ART, a review of your health insurance coverage in consultation with the ART professionals with whom you are working is an important first step in realizing your dream.

Rich Vaughn
Rich Vaughn
clients@lseo.com

Attorney Rich Vaughn is founder and principal of International Fertility Law Group, one of the world’s largest and best-known law firms focused exclusively on assisted reproductive technology, or ART, including in vitro fertilization (IVF), surrogacy, sperm donation or egg donation. Rich is co-author of the book “Developing A Successful Assisted Reproduction Technology Law Practice,” American Bar Association Publishing, 2017.

Peiya Wang
PEIYA WANG(王培娅)
Paralegal (律师助理)

Peiya Wang joined IFLG as a paralegal in 2015, where she manages surrogacy, egg donation and parental establishment cases and provides translation services for many of IFLG’s international clients. Peiya received her bachelor’s degree from Beijing Technologies and Business University, where she majored in Marketing. She moved to the United States in 2012 to attend Northeast University in Boston, Massachusetts, receiving a Master of Science degree in Global Studies and International Affairs in 2014. Peiya moved to Los Angeles in 2015 and received her paralegal certification from UCLA Extension. When away from the office, Peiya is a dragon boat paddler and a ballroom dancer, where she favors Rumbas and Cha-chas. She is fluent in Mandarin and English.

Luis Sosa
LUIS SOSA
Paralegal

Luis R. Sosa joined IFLG as a paralegal in 2016, where he enjoys pursuing his passion for family and reproductive law. While working toward his bachelor’s degree at Florida International University, Luis worked as a paralegal and legal assistant for family law litigation firms in Miami and Washington, D.C. As a paralegal and case manager for IFLG, Luis, who is bilingual in English and Spanish, manages surrogacy, egg donation and other reproductive law cases. In addition to spending time with husband Randy and dog Marty, Luis enjoys being outdoors and appreciating the arts.

Toni Hughes
TONI HUGES
Paralegal

After receiving her B.S. in Business Management, Toni joined IFLG to pursue her dream of working in the legal field. As a Paralegal with over 10 years of experience in the assisted reproduction technology field, Toni is our Managing Paralegal, responsible for training and managing our paralegal staff. From drafting legal documents to assisting our clients with post-birth matters, Toni embraces the challenge of learning something new in this field each day. Besides spending time with her son, Jordan, Toni enjoys exploring new things, cooking, spending time with family and friends, and serving as a Youth Advisor for “Next Generation.”

Miesha Cowart
MIESHA COWART
Financial Coordinator

Miesha Cowart joined IFLG as a financial specialist in 2014 following a successful career in development and business finance. Miesha previously worked for 10 years in the construction industry as a controller and for 13 years as Development Coordinator for the non-profit U.S. Fund for UNICEF. In her free time, Miesha works with “Next Generation” at her church. “They are my heartbeats!” she says of the youth in her community.

Kim
KIM DEVEREAUX
Paralegal

Kim has over 25 years of experience in the legal field and has worked exclusively in surrogacy and assisted reproduction law since 1999. Kim is a senior case manager of surrogacy and egg donation cases, and is also responsible for managing parental establishment cases and interacting with IFLG’s Of Counsel attorneys across the country. With three children of her own, Kim understands the importance of family and finds working in this area of law a rewarding experience.

Rich Vaughn
RICHARD B. VAUGHN
Founder

Attorney Rich Vaughn combined his personal passion as a father of twin boys born via assisted reproductive technology (ART) with more than 20 years of experience in business and technology law to build International Fertility Law Group. Today IFLG is one of the most successful and best-known law firms in the world focused exclusively on fertility law, helping thousands of intended parents through empathetic listening, compassionate guidance, and unmatched legal expertise. As an advocate for reproductive freedom, Rich also contributes his knowledge and time to improving the understanding and practice of ART law, most recently as a founder of and speaker at the first Cambridge University International Surrogacy Symposium held in June 2019, as immediate past chair of the American Bar Association ART Committee, and as a popular presenter to law schools, faculty and advocacy organizations all over the world.

Elizabeth Tamayo
ELIZABETH TAMAYO
Paralegal

Elizabeth received her Bachelors of Science degree in Criminal Justice from California State University of Los Angeles. Shortly after graduating, she continued her education at the University of California, Los Angeles where she obtained her Paralegal certificate. Elizabeth is fluent in Spanish and has been in the legal field since 2009. She is excited to be a part of the IFLG Team helping families realize their dreams.

Sunny Chien
SUNNY CHIEN
Paralegal

Sunny joined IFLG as a paralegal in 2017, where she manages surrogacy, egg donation and parental establishment cases for many of IFLG’s international clients. She holds a Bachelor of Arts degree in Philosophy from California State University of Los Angeles, where she graduated cum laude. Sunny is bilingual in English and Mandarin and has extensive experience as a legal assistant and paralegal at Los Angeles-area law firms. She is excited to be part of the IFLG team. In her spare time, Sunny enjoys spending time with her family and their dog, going to the beach, cooking, and being outdoors.

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Molly O'Brien
MOLLY O'BRIEN
Partner

Fertility law attorney Molly O’Brien began working in the field of assisted reproduction technology (ART) in 2005, at an egg donation agency and a surrogacy agency where she became familiar with all aspects of in-vitro fertilization, egg donation and the financial aspects of surrogacy. Since becoming an attorney in 2011, Molly has drafted and negotiated surrogacy, egg donation, sperm donation embryo donation agreements for hundreds of her clients all over the world.