|
Effective 10/01/00, Maryland Insurance Article Section 15-810 "Benefits for In Vitro Fertilization" was amended and several changes were made the law. This Maryland law requires health and hospital insurance policies, issued within the state, that provide pregnancy benefits to also cover the cost of in vitro fertilization. Below is a summary of the main points in the mandate. To review the actual statue or regulation , go to the links section of www.mdinsurance.state.md.us
- The patient must be a policy holder or subscriber, or a covered spouse of the policy holder or subscriber.
- There is a limit of three IVF attempts per live birth; not to exceed a maximum lifetime benefit of $100,000.
- The patient is unable to get pregnant through less expensive covered treatments.
- IVF must be performed at a facility which conforms to the standards set by the American Fertility Society and the American College of Obstetricians and Gynecologists.
Medical Criteria
- The patient and his or her spouse must have at least a two year history
of infertility OR
- Infertility must be associated with one or more of the following conditions:
- Endometriosis; or
- Fetal exposure to diethylstilbestrol, also known as DES; or
- Blocked or surgically removed fallopian tubes; or
- Abnormal male factors, including oligospermia, contributing to the infertility
Exemptions
- Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide the IVF coverage. [Code of Maryland Regulations (COMAR) 31.11.06.06 (B) (11).]
- Religious organizations offering health benefits to their employees may request that carriers exclude IVF benefits; there must be bona fide religious beliefs and practices which prohibit IVF.
|
