The General Assembly of Maryland recently enacted SB0416, “Health Insurance – Coverage for Infertility Services” effective 1 July 2015, prohibiting insurance carriers from requiring specified conditions of coverage for specified fertility benefits (including IVF, in some cases) for patients with same-sex spouses.
The bill clarifies that carriers that provide pregnancy-related benefits may not exclude benefits for outpatient expenses related to IVF for married couples if, for a patient whose spouse is of the opposite sex, the patient’s oocytes are fertilized with the patient’s spouse’s sperm.
Additionally, the IVF coverage requirements do not apply to certain health insurance policies (often small group policies) where IVF benefits are not essential health benefits.
FOR KAISER PERMANENTE MID- AND LARGE- GROUP MEMBERS
As required by the amended legislation, effective July 1, 2015, Kaiser Permanente now covers in vitro fertilization (IVF) for same-sex married couples. Kaiser Permanente will continue to cover IVF for members in opposite-sex marriages.
IVF is covered for a member if:
- Member and the member’s spouse have a history of involuntary infertility (subject to certain clinical guidelines) or the infertility can be associated with any of the following: endometriosis; exposure in utero to diethylstilbestrol, commonly known as DES; blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or abnormal male factors, including ogliospermia, contributing to the infertility;
- Member has been unable to attain a successful pregnancy through a less costly infertility treatment covered under the member’s Kaiser Permanente health benefit plan;
- For opposite-sex married couples, the member’s oocytes are fertilized using the member’s spouse’s sperm; and
- IVF procedures are performed at medical facilities that meet applicable guidelines or minimum standards set by the American College of Obstetricians and Gynecologists or the American Society for Reproductive Medicine.
IVF coverage is subject to limits, including a lifetime maximum dollar amount for such treatments. Kaiser will update group Evidence of Coverage accordingly.
Contact your Kaiser Permanente account manager or your broker for more information.