Ask The Experts – Insurance Coverage
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Question:
Which insurance company has the most favorable coverage for infertility treatment?
Answer:
The package of insurance coverage for infertility treatment is not up to the insurance company, per se. It is typically up to an employer to determine the scope of coverage that is offered by its insurance company, and whether that package includes compensation simply for diagnosis of infertility, or whether it also covers treatment.
Moreover, one cannot assume that coverage will be the same from one employer to another even if that company uses the same insurer. For instance, an employee of Bank of America with Kaiser coverage might have a completely different insurance package for infertility as compared to an employee of Wells Fargo who also has Kaiser insurance. Through negotiation, an employer may choose an insurance plan with more or less infertility coverage than the average plan.
Another caveat has to do with state regulations. A total of 12 states in the United States have passed laws mandating infertility insurance coverage. However much of this regulation is considered a “soft mandate” meaning the insurers only have to offer it to employers who can choose to take it or leave it. California has a soft mandate so companies here are not legally obligated to purchase coverage for its employees.
A more forceful “hard mandate” requires a company to actually provide it, not just offer it. Massachusetts and Illinois are two states that have this hard mandate.
An exception to this is when a company is self-insured and is not legally required to follow state mandates. Because the majority of people with employer-sponsored health insurance policies are “self-insured”, the mandates do not apply to the majority of people, even in states with mandates.
Obviously, people who are self-employed and therefore pay for their own insurance might have a greater motivation to research those insurance companies that might have more comprehensive infertility coverage. Watch for subsequent articles in Fertility Flash that address this question for people who purchase insurance directly from insurance companies. In addition, the financial consultants at Pacific Fertility Center are available to work with our patients so they receive the benefits their insurance company provides. Click here for more Insurance Information.
– PFC Financial Consultants
Tags: California, Financial
July 2nd, 2010 at 10:39 am
Patients without comprehensive infertility coverage may provide some relief from the tax code. Most infertility treatments costs along with travel costs are considered tax deductible. Un-reimbursed medical expenses above 7.5% of adjusted gross income are eligible to be deducted. Use of a flexible spending account will help reduce costs for those patients not reaching the 7.5% hurdle.
Supplemental insurance may make sense for patients with a high probability of conception. It covers pregnancy disability leave, maternity leave, and may pay added benefits for pre-term delivery of multiples.