Connecticut
Coverage Mandate 1:
Yes
Individual and group health insurance policies must provide coverage for the medically necessary expenses of the diagnosis and treatment of infertility, including, but not limited to, ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer. Conn. Gen. Stat. §§ 38a-509(a); 38a-536(a).
“Infertility” means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. Id.
Individual and group health insurance policies must provide coverage for the medically necessary expenses of the diagnosis and treatment of infertility, including, but not limited to, ovulation induction, intrauterine insemination, IVF, uterine embryo lavage, embryo transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer. Conn. Gen. Stat. §§ 38a-509(a); 38a-536(a).
“Infertility” means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. Id.
Scope of Mandate 2:
Not covered under the state Medicaid program. Conn. Admin. Code 17b-262-342(8).
Coverage Cap 3:
Lifetime maximum coverage of 4 cycles of ovulation induction.
Lifetime maximum coverage of 3 cycles of intrauterine insemination.
Lifetime maximum coverage of 2 cycles of IVF, GIFT, ZIFT or low tubal ovum transfer, with not more than 2 embryo implantations per cycle. Each fertilization or transfer is credited as one cycle towards the maximum.
Limits coverage for IVF, GIFT, ZIFT and low tubal ovum transfer to individuals who have been unable to conceive or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures, unless the individual’s physician determines that those treatments are likely to be unsuccessful.
Requires infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
Lifetime maximum coverage of 3 cycles of intrauterine insemination.
Lifetime maximum coverage of 2 cycles of IVF, GIFT, ZIFT or low tubal ovum transfer, with not more than 2 embryo implantations per cycle. Each fertilization or transfer is credited as one cycle towards the maximum.
Limits coverage for IVF, GIFT, ZIFT and low tubal ovum transfer to individuals who have been unable to conceive or sustain a successful pregnancy through less expensive and medically viable infertility treatment or procedures, unless the individual’s physician determines that those treatments are likely to be unsuccessful.
Requires infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
Requirements or Limitations on Coverage 4:
To meet the definition of infertility, the individual must be unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or infertility treatment must be medically necessary. Gen. Stat. §§ 38a-509(a); 38a-536(a).
Exemptions 5:
Yes, for religious organizations
Any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets. Conn. Gen. Stat. §§ 38a-509(c)(1); 38a-536(c)(1)
“Religious employer” means an employer that is a “qualified church-controlled organization”, as defined in 26 USC 3121 or a church-affiliated organization. Conn. Gen. Stat. §§ 38a-509(e); 38a-536(e).
Upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods. Conn. Gen. Stat. §§ 38a-509(c)(2); 38a-536(c)(2).
Any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for methods of diagnosis and treatment of infertility that are contrary to the religious employer's bona fide religious tenets. Conn. Gen. Stat. §§ 38a-509(c)(1); 38a-536(c)(1)
“Religious employer” means an employer that is a “qualified church-controlled organization”, as defined in 26 USC 3121 or a church-affiliated organization. Conn. Gen. Stat. §§ 38a-509(e); 38a-536(e).
Upon the written request of an individual who states in writing that methods of diagnosis and treatment of infertility are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for such methods. Conn. Gen. Stat. §§ 38a-509(c)(2); 38a-536(c)(2).
Fertility Preservation:
Yes
Effective 1/1/18.
Effective 1/1/18.
Notes
1 Does the state have a coverage mandate, Y/N. Include effective date of the mandate. Specify if the mandate is to “offer” services or to “cover” them.
2Which insurers are required to comply with the mandate. If not applicable, put N/A.
3Is there a cap (annual/lifetime)?
4Does the law impose age restrictions on eligibility for coverage? Does it limit the number of IVF cycles covered (or require at least a certain number of services be covered)? Does it mandate a waiting period? Other limitations? How is “infertility” defined? Is it inclusive (e.g.: does it apply only to married or -opposite sex couples, or is it inclusive?)
5What, if any, exemptions apply to coverage under the mandate? For example: an exemption for small businesses or religious organizations.
Resources For You
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