This article will examine current US health insurance policies for providing fertility services and Assisted Reproductive Technologies and analyze the open-ended policies of the Commonwealth of Massachusetts. This state in particular will be discussed in depth, as there are virtually no limits on infertility provision or coverage. However, tightening up Massachusetts’s health insurance policies by putting parameters on provision and coverage of Assisted Reproductive Technologies will allow the infertile to continue to access paid-for treatment while ensuring that the goal of health insurance coverage—which I understand to be the provision of paid coverage to address medical conditions—is maintained.
For instance, the UK’s NHS provides funding up to three cycles and “Israel provides free, unlimited IVF procedures for up to two ‘take-home babies’ until a woman is 45.” NHS. Fertility: Assessment and treatment for people with fertility problems, 2013; Kraft D. Where families are prized, help is free. The New York Times July 17, 2011.
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This will likely change with the full implementation of the Affordable Care Act, although ART services will be low on the list of standardization and will likely not be considered necessary for minimum coverage.
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Government programs that do not cover ARTs include the Federal Employee Health Benefits Programs [FEHBP], the Medicaid program and Tricare, the military’s health care program. Division of health care finance and policy, review and evaluation of proposed legislation entitled: An act relative to increasing coverage for infertility treatments Senate bill 485 provided for the joint financial services committee. August 2009:9.
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WHO. Infertility definitions and terminology, 2013.
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Practice Committee Report, the American Society for Reproductive Medicine. Definition of infertility and recurrent pregnancy loss. Fertil Steril2008; 90(Suppl 3): S60–S60.
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Mayo Clinic. Infertility: Causes of infertility, 2011.
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Center for Disease Control. Sexually transmitted diseases in the United States, 2008.
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This is not to denigrate single motherhood or lesbian parenthood, but rather highlights that there are sometimes social rather than biological factors driving the pursuit of ARTs. When these are paid for and coded under “infertility services,” the purpose of health insurance and medical treatment, as defined above, are overshot.
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The National conference of state legislatures and the American society for reproductive medicine. State laws related to insurance coverage for infertility treatment, 2012.
Tex. Insurance Code Ann. § 1366.001 et seq. 1987, 2003.
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La. Rev. Stat. Ann. § 22:1036 2001.
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N.Y. Insurance Law § 3216 13, § 3221 6 and § 4303 1990, 2002, 2011, amended in 2011 N.Y. laws, Chap. 598 2011.
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Network Health. Are there any services network health does not cover? 2013.
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R.I. Pub. Laws, Chap. 411, SB 453 2007.
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N.Y. Insurance Law § 3216 13, § 3221 6 and § 4303 1990, 2002, 2011.
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Hawaii Rev. Stat. § 431:10A-116.5 and § 432.1–604 1989, 2003.
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Tex. Insurance Code Ann. § 1366.001 et seq. 1987, 2003.
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Md. Insurance Code Ann. § 15-810 2000.
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Cal. Insurance Code § 10119.6 1989.
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Conn. Gen. Stat. § 38a-509 and § 38a-536 1989, 2005.
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R.I. Gen. Laws § 27-18-30, § 27-19-23, § 27-20-20 and § 27-41-33 1989, 2007.
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Mass. Gen. Laws Ann. ch. 175, § 47H, ch. 176A, § 8K, ch. 176B, § 4J, ch. 176G, § 4 and 211 Code of Massachusetts Regulations 37.00 1987, 2010; SB 2585 2009–2010.
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R.I. Gen. Laws § 27-18-30, § 27-19-23, § 27-20-20 and § 27-41-33 1989, 2007.
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Hawaii Rev. Stat. § 431:10A-116.5 and § 432.1–604 1989, 2003.
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Md. Insurance Code Ann. § 15-810 2000.
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Ill. Rev. Stat. ch. 215, § 5/356m 1991, 1996.
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St. 2006, c.58; MGL c.111M 2008.
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Division of health care finance and policy: 4.
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Massachusetts general laws ann. Ch. 175, Section 47H, ch. 176A, Section 8K, ch.176B, Section 4J, ch 176G, Section 4, and 211 CMR 37.00 1987, amended in 2010.
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Division of health care finance and policy:1.
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Gibson F, Ungerer J, Tennat C, et al. Parental adjustment and attitudes to parenting after in vitro fertilization. Fertil Steril 2000; 73: 565–574; Golombo, S, MacCallum F and Goodman E. The ‘test-tube’ generation: parent–child relationships and the psychological well being of in vitro fertilization children at adolescence. Child Dev 2001; 72: 599–608.
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Even so, the inability to have a biological child due to social factors can be a source of mental pain and could be addressed by the health care system through counseling to accept a childfree life or even assistance in locating a child to adopt. Yet, these services cannot be considered a part of “infertility treatment” in the strict sense. They are instead, mental health care and clearly not an aim of “infertility services.” Health insurance can and does cover mental health care, but ARTs given under health care policy should address a physical defect and not an emotional desire.
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Division of health care finance and policy:14.
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Haimov-KochmanRImbarTFarchatM. Adolescent infertility – to treat or not to treat. Fertil Steril2008; 90: 1–4.
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TownerDLoewyRSEthics of PGD for a woman destined to develop early-onset Alzheimer disease. In: ShannonTA (ed). Genetics: Science, Ethics, and Public Policy, Lanham, US: Rowman and Littlefield, 2005, pp. 75–79.
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U.S. Census Report. Fertility of American women, 2010.
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American Society of Reproductive Medicine. Frequently asked questions about infertility, 1996–2013.
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JollyMSebireNHarrisJ. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod2000; 15: 2433–2437.
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MaliziaBAHackerMRPenziasAS. Cumulative live-birth rates after in vitro fertilization. New Engl J Med2009; 360: 236–243.
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Of course, some single women and lesbians are infertile and would be considered as such for health insurance purposes.
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Fertility Associates. Public funding and eligibility, ND.
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Sparrow R. Is it ‘Every man’s right to have babies if he wants them’? Male pregnancy and the limits of reproductive liberty. Kennedy Inst Ethics J 2008; 18: 275–299; Alghrani A. Assisted reproductive technologies and family formation: womb transplant technology and the allocation of family responsibilities. In: Lind C, Keating H and Bridgeman J (eds) Taking Family Responsibility or Having it Imposed: Recognising Law’s Limitations? Aldershot, UK: Ashgate, 2010, pp.221–236.
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Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet epub ahead of print 5 October 2014. DOI:10.1016/ S0140-6736(14)61728-1.
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The Ethics Committee of the American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons. Fertil Steril2009; 92: 1190–1193.
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Kauffman H. Designer Babies Ethical? CBS News March 3, 2009.
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SidhuJ. Gender selection has become a multimillion-dollar industry. Slate September 17, 2012; Qian N. Missing women and the price of tea in China: the effect of sex-specific earnings on sex imbalance. Q J Econ2008; 123: 1251–1285.
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