Maternity – Birth Control – Infertility

Infertility on California Group Plans

• IVF covered in CA new law 
  • New law that requires large health insurance companies to cover in vitro fertilization
    • The bill also expands healthcare benefits to LGBTQ+ families seeking to have children, changing the definition of infertility for insurance purposes to include “a person’s inability to reproduce either as an individual or with their partner without medical intervention.”  Read more >>>  Los Angeles Times
  • SB 729 Treatment for infertility & fertility services
    • large and small group health plans issued or renewed after July 1, 2025,  must  provide coverage for the diagnosis and treatment of infertility and fertility services.  It will remove the exclusion of in vitro fertilization from coverage.
  • KFF News

Excerpt from Health Net Plan Guide

• infertility – CA Law? and newborn care.
  • §146.130   Standards relating to benefits for mothers and newborns.
  • Maternity: Inpatient hospital and ambulatory
    • Prescription drug coverage for contraceptives
    • Maternity hospital stay
    • Sterilization operations and procedures   ^{View the Affordable  health ca.com page  Assembly Bill 1453 (Monning) and Senate Bill 951 (Hernandez).   View the California Health and Safety Code, section 1367.005}
    • ivf  specialists.com
  • If You’re Poor, Fertility Treatment Can Be Out of Reach
• Federal?
  • Former President Donald Trump announced Thursday that he would ensure the government or insurance companies would fully pay for people’s IVF treatments, without providing details on how.  August 2024 19th News

• IVF – Fertility Treatments 

   

  • Even When IVF Is Covered by Insurance, High Bills and Hassles Abound
  • Should health insurers cover the cost of fertility treatment?
  • Overturning Roe V. Wade: Here’s How It Could Impact Fertility Treatments And IVF
  • Aetna Clinical Bulletin Infertility
  • Infertility Definition
    • May be either of the following:
      •  A demonstrated condition recognized by a licensed Physician or surgeon as a cause for Infertility; or
      •  The inability to conceive a pregnancy or to carry a pregnancy to a live birth after a year of regular sexual relations without contraception.
  • Fertility preservation services
    • Fertility preservation services are covered for Members undergoing treatment or receiving Covered Services that may directly or indirectly cause iatrogenic Infertility. Under these circumstances, standard fertility preservation services
      • reproductive facts.org/infertility-insurance-laws/california
      •  Kaiser
      • kff.org/coverage-and-use-of-fertility-services-in-the-u-s
    • are a Covered Service.
    • Exclusion
      • Any services related to assisted reproductive technology (including associated services such as radiology, laboratory, medications, and procedures) including but not limited to
        • the harvesting or stimulation of the human ovum,
        • in vitro fertilization,
        • Gamete Intrafallopian Transfer (GIFT) procedure,
        • Zygote Intrafallopian Transfer (ZIFT),
        • Intracytoplasmic sperm injection (ICSI),
        • preimplantation genetic screening,
        • donor services or procurement and storage of donor embryos,
        • oocytes, ovarian tissue, or sperm,
        • any type of artificial insemination, services or medications to treat low sperm count, or services incident to reversal of surgical sterilization,
        • except for Medically Necessary treatment of medical complications of the reversal procedure.  Specimen Policy use Ctrl F to find
  • Alabama Republicans want to give IVF doctors immunity after court rules frozen embryos are kids
  • Senate Democrats Plan Speedy Action In Defense Of IVF Treatments
• Federal Law 
  • Only 1 in 4 employers provide IVF – legislature wants all plans to cover it.  NPR October 2024

Birth Control – Contraception

• • Birth control benefits
    • Why So Many Women Are Waiting Longer to Have Kids Time Magazine April 2024
    • Plans in the Health Insurance Marketplace® must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.
    • Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.
    • Covered contraceptive methods
      • FDA-approved contraceptive methods prescribed by a woman’s doctor are covered, including:
        • Barrier methods, like diaphragms and sponges
        • Hormonal methods, like birth control pills and vaginal rings
        • Implanted devices, like intrauterine devices (IUDs)
        • Emergency contraception, like Plan B® and ella®
        • Sterilization procedures
        • Patient education and counseling
  • Plans aren’t required to cover drugs to induce abortions and services for male reproductive capacity, like vasectomies.
    Notice:
  • TIP To be sure if a specific method is covered by your plan, check your plan’s materials or ask your employer or benefits administrator.
  • Birth control benefits rules for employer-provided coverage
  • If you work for a religious employer
  • Health plans sponsored by certain exempt religious employers, like churches and other houses of worship, don’t have to cover contraceptive methods and counseling.
  • If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information.
  • If you work for a non-profit religious organization
  • Some non-profit religious organizations — like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage — don’t have to contract, arrange, pay, or refer for contraceptive coverage.
    If your health plan is sponsored or arranged by this type of organization, an insurer or third party administrator will make separate payments for contraceptive services that you use.
  • You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider.
  • Contact your employer or health plan to learn more.  health care.govbirth-control-benefits
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  • Insurers must provide contraceptive coverage at no cost or face potential enforcement action, according to new federal guidance meant to counter reports of coverage denials.
    • UnitedHealth got caught and has been ordered to reimburse the member — and all others in her situation — for the out-of-pocket costs they incurred.   LA Times June 2024
    • Why It’s So Hard to the Get Birth Control You Want Covered by Insurance Time Magazine
    • HHS, Labor and Treasury put insurers on notice about ACA contraception coverage
    • Contraception’s Complains 
    • Top Biden officials press insurers on contraceptive coverage Advocates for broad coverage say insurers are skirting the rules and denying coverage in some cases

• HHS Warns Insurers Of Penalties If Birth Control Is Not Covered
• California Wants to Snip Costs for Vasectomies
• Our webpage on Preventative Care 
• Search Ctrl F  *   Specimen Policy  *  for contraception
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