A couple experiences infertility when they have not become pregnant after at least one year of having sex without using birth control methods. Couples who meet with a doctor regarding their infertility issues will discuss lifestyle issues and also determine what medical tests and counseling are needed as part of their infertility treatment. Up to 30% of couples may not find a reason for their infertility.
Traditional health insurance coverage
Many health insurance plans and policies will cover some aspects of infertility diagnosis, but the tests and treatment coverage a couple can receive will vary from one insurance policy to another. This is the case regardless of whether a couple has insurance through their employer or purchased independently through a broker, the Healthcare Marketplace or through a public option.
It is smart to check your plan for the coverage that you have. Many cover a diagnosis, but treatment for infertility is sometimes considered “voluntary” by some traditional health insurance plans. According to RESOLVE, 17 states mandate or require that insurance offer coverage of infertility treatment, such as IVF and IUI. In most cases, these mandates are far from complete or comprehensive.
Infertility as a medical diagnosis
The American Society of Reproductive medicine declared “infertility is a disease of the reproductive system that impairs the body’s ability to perform the basis function of reproduction” in 1993. But the American Medical Association did not agree with this until much later in 2017 said David Adamson, M.D. This explains why even though infertility is a medical diagnosis, traditional health insurance still considers expensive treatments elective or unnecessary.
Even the Affordable Care Act which was designed to increase access to healthcare for more Americans does not consider infertility treatment as an Essential Health Benefit.
Types of infertility treatment
A couple exploring treatment for infertility could undergo hormone testing, imaging, genetic testing, ovulation testing, or other initial tests, in order to determine their cause for infertility. According to the American Society for Reproductive Medicine, a standard workup includes a semen analysis, ovulation assessment, a hysterosalpingogram, and possibly, tests for ovarian reserve and laparoscopy. Once a doctor has enough information needed, then he or she will put a treatment plan in place for the couple. Their treatment plan could include IUI to start and then add IVF later.
What is IUI?
IUI (intrauterine insemination, formerly called artificial insemination) and IVF (in vitro fertilization) are two commonly prescribed treatments for infertility. Intrauterine insemination (IUI) describes the technique of placing sperm into a woman’s uterus when she is ovulating.
This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus issues.
IUI is a more cost-effective solution and is often done in conjunction with ovulation-stimulating drugs; it is typically prescribed before a doctor proceeds with IVF treatments.
What is IVF?
In Vitro Fertilization (IVF) is a type of assisted reproductive technology (ART) and it was introduced in the U.S. in 1981. It describes a technique where a woman’s eggs and man’s sperm are combined in a laboratory in order to create an embryo(s). Depending on the diagnosis and age of the woman, an embryo or embryos are transferred to the woman’s uterus through her cervix to enhance the chances of pregnancy.
One round of In Vitro Fertilization (IVF) can cost $12,400 according to the American Society of Reproductive Medicine. However, if the cost of medications, egg storage and genetic testing are included, the true cost can be much higher. FertilityIQ estimates it can cost $23,000 per cycle, and that couples pursuing IVF may need on average 2-3 cycles for a successful outcome.
LifeSpring’s infertility insurance policy is a supplemental health insurance policy purchased for Texas children ages 0-13 that provides the beneficiary couple up to $50,000 of coverage following a diagnosis of primary infertility when they are older. It was designed to give the next generation of couples affected by infertility the hope and financial resources they need.
The primary infertility assistance policy covers primary infertility treatments for the beneficiary couple, including medication, testing, doctor visits, IUI, IVF, anesthesia, egg/sperm/embryo storage and other related treatments with no deductibles or co-insurance. The one-time purchase does not need to be renewed.
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 or smart phone. In about the time it takes to order a coffee drink from your favorite coffee bar, you can receive a custom quote after answering a few short questions.
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
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
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
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
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 firstname.lastname@example.org.