Starting in January, health insurance for some Colorado residents will cover in-vitro fertilization, but as much as the state is trying to expand coverage, it won’t work for everyone.
House Bill 1008, which passed this spring, requires large group health plans run by the state to provide full coverage for infertility. People with certain types of health insurance may have some coverage, but they have limitations.
Here are answers to common questions about it a new law:
How do I know if this works for me?
First, check your insurance card. If it says “CO-DOI” somewhere on the card, your insurance is regulated by the state. If not, this new service does not apply to you. It was like that too other important things to learn government that has been implemented in recent years, such as the out-of-pocket cost of insulin.
Only large group plans administered by the Colorado Division of Insurance fall under the new mandate, though. You can’t tell by looking at the card if your insurance policy is a large or small group, so you should call your employer’s department or your insurance company to confirm.
Religious organizations are allowed to ask their insurance plans not to provide certain birth control services they refuse, but they must notify employees if they do.
If you have Medicaid or another type of government-sponsored health insurance, the service does not apply to you.
I’m covered. What does that mean?
Starting in January, you have a fertility treatment that seems to be suitable under Guidelines of the American Society of Reproductive Medicine. This may include preventive measures, such as freezing the eggs before the mother receives cancer treatment.
For people who need in-vitro fertilization, insurance must cover three egg retrievals and unlimited embryo transfer attempts. IVF involves stimulating the ovaries with drugs to produce more eggs, which are removed and combined outside the body with sperm from a partner or donor. They are then transferred into the body, which leads to successful pregnancy and childbirth.
Plans are not allowed to place more restrictions on fertility drugs than they have on other drugs, and they may not set deductibles or require higher out-of-pocket costs. This still leaves a difference, though: a family with the cheapest insurance plan has to pay more out-of-pocket for infertility care than those who pay a higher monthly premium in exchange for lower costs when using care.
This service uses American College of Obstetricians and Gynecologists’ definition of infertility, which is failure to conceive after one year of regular intercourse without contraception for women under the age of 35 and six months without success for older women. It also allows treatment if a doctor diagnoses infertility in another way.
My system is not under control. Do I have any help?
Some infertility services have been considered a priority for health in Colorado since 2017. This means that individual and small plans must cover tests to detect infertility, as well as artificial reproduction, without additional barriers or costs.
They don’t have to cover IVF or freeze eggs to prevent infertility. It’s not uncommon, but some companies choose to add infertility coverage, so check with your insurance provider before starting treatment.
It is possible that you will have additional coverage at some point in the future, if the US Department of Health and Human Services withdraws it.
Why do some plans only need government approval?
The Colorado Division of Insurance must decide whether any expansion will be a new job when it comes to the plans of the state’s largest insurance groups. It determined that the need for most reproductive services to be paid for fell below what was available for assisted reproduction.
For public purposes or small groups, the US Department of Health and Human Services must agree that it is not a new activity. A separate bill which called for the expansion of fertility that took place in 2020 and sent the proposal to HHS for approval, but the department did not agree with the government and it was rejected as a new project.
The 2022 bill introduced state-run plans (those that don’t require federal approval) to provide certain people with information starting in January. The insurance sector is still working to convince HHS to approve coverage of more fertility treatments for individuals with private and group health insurance.