Many of us look forward to the day when we are ready to have our children or grandchildren. The desire to have our own biological children is strong. In a recent poll conducted by Harris Poll, more than 4 in 5 parents who still have children under 18 living at home (82%) say it is important to them for their children to have their own biological children one day.* But 12% of all couples, or 1 in 8, are impacted by infertility. Health insurance is often what we turn to if we need medical treatments for any diagnosis, but coverage varies widely depending on your plan. The vast majority of plans, even group health plans, do not usually cover all of the infertility treatments that are needed for successful results.
How does infertility insurance help?
Infertility insurance or assisted reproduction insurance is an insurance policy that specifically covers medical procedures related to a diagnosis of primary infertility. It is purchased to reduce your financial risk if you and your partner face this medical diagnosis. The diagnosis of infertility affects both partners, so the diagnosis and treatment is often needed for both. The good news is that most couples — 85% to 90% — who seek and receive treatment are treated with conventional medical therapies such as medication or surgery to have their own child. Many of these will eventually be able to have their own biological child. The main barrier for families is the high cost of infertility treatment.
What kind of coverage do traditional health plans offer?
Traditional health insurance for most families in the United States is purchased through an employer or purchased independently either through a broker or through the Healthcare Marketplace. Despite the passage of the Affordable Care Act (2010) — which mandated expanded healthcare rights and protections including coverage for preexisting conditions and preventative care — infertility treatment, including Intrauterine Insemination (IUI) and assisted reproduction technology such as In Vitro Fertilization (IVF), were missing from this insurance mandate. This means that infertility benefits are largely absent from many traditional health plans.
Seventeen state legislatures have stepped in to pass legislation in effort to require that traditional health plans include some benefits for IVF (see a list of what is mandated by state), but they are far from complete or comprehensive. Also, employers may opt-out of infertility coverage as a way to lower their costs. In Texas, health insurers are required to “offer” but not “cover” IVF and related services. In order to qualify for IVF services, the couple must have a five-year history of infertility or have specified medical conditions that caused the infertility diagnosis. And the law includes exemptions for religious employers.
These mandates do not address the numerous medications and medical procedures that are commonly used to diagnose and treat a couple with primary infertility. And, employer self-funded health insurance plans aren’t subject to state laws. With so many exceptions and exclusions, it can be a frustrating exercise to count on traditional health plans to cover all of the expenses to resolve an infertility diagnosis.
Can I advocate for infertility insurance coverage from my employer?
The short answer is yes, but it can be a long road. Some recommend asking an employer directly to pursue an insurance rider, basically a plan add-on, to cover infertility treatment benefits because companies may not be aware that it is a benefit that is missing and desired by their employees. This type of rider is expensive, so many times companies will opt not to include it. RESOLVE has a toolkit for employees who want to pursue this option.
Can I advocate for infertility treatment coverage from my health insurance plan?
The short answer is probably not. While some might advocate asking your traditional health plan insurance provider to cover a health diagnosis, they likely will not be able to make an exception. Exceptions could be perceived as a bias and opens the insurance carrier up to having to cover others.
Traditional health plans are admitted and regulated by each state’s Department of Insurance, and these state agencies require that insurance, such as health insurance is applied without discrimination or preferential treatment.
The federal Affordable Healthcare Act requires coverage of essential health benefits, but infertility treatment is not considered part of those. According to the U.S. Health and Human Services, “Plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.”
In the case of Texas, the Texas Department of Insurance includes infertility diagnosis in the mandated health benefits, but not treatment in its benchmark plan of health coverage. “State law mandates an offer of coverage for in vitro (IVF) in the group market, but does not require each employer to elect this coverage.”
Can supplemental health insurance be used to cover infertility treatment expenses?
Yes. Supplemental health insurance is a type of insurance that can fill the gaps that exist with traditional health plans and cover a specific diagnosis like primary infertility. This type of insurance is purchased before any diagnosis. Because insurance involves pooling risk, some who purchase it won’t ever need the benefits while some will. This is what makes supplemental insurance affordable for many people.
LifeSpring Insurance Services offers the country’s first and exclusive supplemental health insurance for primary infertility treatments. This primary infertility assistance policy can be purchased for children ages 0-13. Once covered, the policy pays up to $50,000 for infertility treatments at age 18-35 for the beneficiary child and their future partner once they are ready to start a family.
A number of common infertility treatment procedures, tests and out-patient care are covered under LifeSpring’s infertility insurance policy, including drug therapy, diagnostic testing, IUI, lab tests, IVF, surgical care, egg and sperm retrieval and storage, and more.
The Primary Infertility Assistance Policy can be purchased online by any caring adult for any eligible beneficiary. For a one-time premium, it costs about $2,000 offering today’s adults an opportunity to give the next generation of couples affected by infertility the hope and financial resources they need. Benefits can be used to complement traditional health plans and are paid directly to physicians, medical facilities and pharmacies with no deductible, no copay and no coinsurance. The insurance policy is an admitted plan approved by the Texas Department of Insurance, which regulates the insurance industry and evaluated this plan to ensure it will be available now and in the future.
Are other supplemental insurance plans available?
To our knowledge, there are no other supplemental insurance plans that cover a primary infertility diagnosis for tomorrow’s families. We have seen discount plans and financing programs for infertility treatments. Some may include “insurance” in the name, but they do not cover infertility treatment for tomorrow’s families. Rather, these plans offer financial assistance for medical complications related to infertility for today’s adults undergoing infertility treatments.
Why is a supplemental health policy from LifeSpring Insurance Services the best infertility insurance available?
Navigating traditional health insurance options for covering infertility treatment is complicated to say the least. If you or your partner are self-employed or an entrepreneur, the options are even more expensive for less coverage in most cases. The options are limited even for our servicemen and women. We may not be able to change our nation’s complicated healthcare system or the benefits employers provide, but we can change the way infertility is insured and make it affordable for many more people by covering children when they are younger. In this way, we can remove the barrier of finances so that future families can pursue infertility treatments if they ever need it when ready to have their own biological children.
Can LifeSpring Insurance Services help your future family?
In a Harris Poll conducted in 2019, 78% of parents say it’s important to them that their children can have their own biological children one day. And one in three parents (33%) worry their children may suffer from infertility in the future. But we do not know which couples will have trouble conceiving a child. This is why LifeSpring Insurance Services created a Primary Infertility Assistance Program to cover not only the child but also their future partner and to remove the barrier of finances from the infertility and assisted reproduction technology equation. If you’re looking for the best infertility insurance for your future family, we invite you to learn more about LifeSpring’s infertility insurance policy, see our frequently asked questions, and apply online from the privacy of your home. You will receive a custom quote in about 10 minutes.
* This survey was conducted online within the United States by The Harris Poll on behalf of LifeSpring Insurance Services from October 15 – 17, 2019 among 2,018 U.S. adults ages 18 and older among whom 1,172 are parents. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact email@example.com.