Mandating coverage for

To determine if your HMO provides infertility benefits, you should contact the HMO directly or check your certificate of coverage.

The law exempts religious organizations which believe the covered procedures violate their teachings and beliefs.

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Benefits required to be covered include, but are not limited to: Coverage for treatments that include oocyte retrievals is required only if the covered individual 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.

This requirement shall be waived in the event that the covered individual or partner has a medical condition that renders such treatment useless.

Coverage for such treatments is limited to four completed oocyte retrievals per lifetime of the individual, except that two completed oocyte retrievals are covered after a live birth is achieved as a result of an artificial reproductive transfer of oocytes.

Illinois law requires certain group insurance plans and health maintenance organizations (HMOs) to provide coverage for the diagnosis and treatment of infertility. The law defines infertility as the inability to get pregnant after one year of unprotected sex or the inability to carry a pregnancy to term.

Illinois law requires insurance companies and HMOs to provide coverage for infertility to employee groups of more than 25.

The law does not apply to self-insured employers or to trusts or insurance policies written outside Illinois.However, for HMOs, the law does apply in certain situations to contracts written outside of Illinois if the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois.For example, if a physician determines that one year of artificial insemination has failed and is not likely to lead to a successful pregnancy a woman shall be considered infertile for purposes of this coverage, regardless of whether she satisfies any of the other three categories of infertility.Illinois law requires that coverage for the diagnosis and treatment of infertility be the same as coverage for any other condition covered by the policy.For example, a policy may not apply any unique co-payments or deductibles for infertility coverage.If the policy does not contain a prescription drug benefit it must establish one solely for coverage of prescription drug therapies for infertility.


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