Maryland IVF Mandate

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Maryland IVF Mandate

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 IVF. A summary of the main points in the mandate is shown below. To review the actual statue or regulation, go to the links section of www.mdinsurance.state.md.us

1. The patient must be a policy holder or subscriber, or a covered spouse of the policy holder or subscriber.

2. There is a limit of three IVF attempts per live birth; not to exceed a maximum lifetime benefit of $100,000.

3. The patient is unable to get pregnant through less expensive covered treatments.

Medical Criteria

The patient and his or her spouse must have at least a five 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.