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Maryland Fertility Insurance Coverage

The Maryland Insurance Article Section 15-810, "Benefits for In Vitro Fertilization," requires health and hospital insurance policies issued within the state that provide pregnancy benefits to also cover the cost of in vitro fertilization (IVF). Effective January 1, 2021, Maryland’s Mandated Benefits no longer has a marriage requirement for patients to receive benefits for IVF treatment. There is a limit of three IVF attempts per live birth; not to exceed a maximum lifetime benefit of $100,000.

CRITERIA

For contracts that follow the Maryland mandate, benefits are provided when all of the following criteria are met:

  • The patient must be a policyholder or subscriber, or a covered spouse of the policyholder or subscriber.
  • The patient is unable to get pregnant through less-expensive covered treatments.
  • For patients whose spouse is of the opposite sex, the patient and her spouse must have at least a 1-year history of involuntary infertility or infertility must be associated with one or more of the following conditions
    • Endometriosis
    • Fetal exposure to diethylstilbestrol, also known as DES
    • Blocked or surgically removed Fallopian tubes
    • Abnormal male factors, including oligospermia, contributing to the infertility
  • For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm.
  • For patients whose spouse is of the same sex, there must be three attempts of artificial insemination over the course of 1 year failing to result in pregnancy.
  • IVF must be performed at a facility that conforms to the standards set by the American Fertility Society and the American Congress of Obstetricians and Gynecologists.
EXEMPTIONS
  • Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide 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 that prohibit IVF.

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