Illinois Infertility Health Insurance Laws

The Illinois infertility health insurance laws require that group insurance policies providing coverage for more than 25 employees that include pregnancy-related benefits must include coverage for the diagnosis and treatment of infertility, including IVF, uterine embryo lavage, embryo transfer, artificial insemination, GIFT, zygote intrafallopian transfer (ZIFT), and low tubal ovum transfer. “Infertility” means the inability to conceive after one year of unprotected sexual intercourse or the inability to sustain a successful pregnancy.

Coverage for IVF, GIFT, or ZIFT is required only if

• the patient has been unable to attain or sustain a successful pregnancy through reasonable, less costly, medically-appropriate infertility treatments for which coverage is available under the policy;
• the patient has not undergone four completed oocyte retrievals, except that if a live birth follows a completed oocyte retrieval, then two more completed oocyte retrievals must be covered; and
• the procedures are performed at medical facilities that conform to ACOG guidelines for IVF clinics or to the American Fertility Society minimal standards for IVF programs.

Exceptions include coverage that has been issued to a religious institution who's beliefs may violate the law.

Also, if your employer is self ensured, you may not be covered under the Illinois law. According to the Federal Employee Retirement Income Security Act or ERISA, self-insuring businesses are not required to comply with state insurance mandates, although they may voluntarily provide these mandated benefits. Read the find print in your insurance policy to be sure.

Of course state laws are always in the process of being modified, rolled back, updated, etc. You can find the most current (http://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K356m;Illinois Infertility Health Insurance Law) and compare it to your policy.

In the case of a conflict, the state law will probably override any language in the document, but talk to your lawyer or a legal representative if you have questions.

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