Rhode Island
Coverage Mandate 1:
Yes
Effective 6/16/1991.
Insurers and HMOs that cover pregnancy benefits must also cover medically necessary expenses associated with diagnosis and treatment of infertility, and standard fertility preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
R.I. Gen. Laws §§ 27-18-30(a), 27-19-23(a), 27-20-20(a), 27-41-33(a).
“Infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
Id. §§ 27-18-30(b), 27-19-23(b), 27-20-20(b), 27-41-33(b).
“Iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Id. §§ 27-18-30(d), 27-19-23(d), 27-20-20(d), 27-41-33(d).
Scope of Mandate 2:
The coverage mandate applies to any health insurance contract, plan, or policy delivered, issued, or renewed in the state, except contracts providing supplemental coverage to Medicare or other governmental programs, that provides pregnancy-related benefits. R.I. Gen. Laws § 27-18-30(a).
The mandate expressly includes:
- Blanket or group policies. § 27-18-30(f).
- Any nonprofit hospital service contract, plan, or insurance policy. Id. § 27-19-23(a).
- Any nonprofit medical service contract, plan, or insurance policy. Id. § 27-20-20(a).
- Any HMO service contract plan or policy. Id. § 27-41-33(a).
The statute does not include:
- Employers who self-insure;
- Coverage only for accident, or disability income insurance, or any combination thereof;
- Liability insurance, including general liability insurance and automobile liability insurance;
- Workers’ compensation or similar insurance;
- Automobile medical payment insurance;
- Credit-only insurance;
- Coverage for on-site medical clinics;
- Other similar insurance coverage under which benefits for medical care are secondary or incidental to other insurance benefits;
Coverage Cap 3:
Permissive
The policy may limit coverage to a lifetime cap of $100,000.
R.I. Gen. Laws §§ 27-18-30(g), 27-19-23(f), 27-20-20(f), 27-41-33(f).
Requirements or Limitations on Coverage 4:
Coverage is mandated for diagnosis and treatment of infertility for women between the ages of 25 and 42. Insurers may impose up to a 20% co-payment.
R.I. Gen. Laws §§ 27-18-30(a), 27-19-23(a), 27-20-20(a), 27-41-33(a).
“Infertility” means the condition of an otherwise presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.
Id. §§ 27-18-30(b) , 27-19-23(b), 27-20-20(b), 27-41-33(b).
Coverage is also mandated for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
Id. §§ 27-18-30(a), 27-19-23(a), 27-20-20(a), 27-41-33(a).
“Iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Id. §§ 27-18-30(d), 27-19-23(d), 27-20-20(d), 27-41-33(d).
Exemptions 5:
Employers who self-insure are exempt from the requirements of the law, as are contracts providing supplemental coverage to Medicare or other government programs.
R.I. Gen. Laws §§ 27-18-30(a), 27-19-23(a), 27-20-20(a), 27-41-33(a).
Fertility Preservation:
Yes
Coverage is mandated for standard fertility-preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
R.I. Gen. Laws at §§ 27-18-30(a), 27-19-23(a), 27-20-20(a), 27-41-33(a).
“Iatrogenic infertility” means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Id. §§ 27-18-30(d), 27-19-23(d), 27-20-20(d), 27-41-33(d).
“Standard fertility-preservation services” means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or other reputable professional medical organizations.
Id. §§ 27-18-30(c), 27-19-23(c), 27-20-20(c), 27-41-33(c).
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.
