State mandates for IVF insurance coverage in California

1. State Mandates for IVF Insurance Coverage in California

- According to state regulations, all insurance plans that cover pregnancies in California are required to also cover fertility treatments such as IVF.

- All individual and group health insurance policies, including HMOs and PPOs, must cover fertility treatments.

2. California Insurance Code Section 1374.55

- California Insurance Code Section 1374.55 establishes state mandates for IVF insurance coverage.

- All individual and group health insurance policies must cover the diagnosis and treatment of infertility, including IVF, under this clause.

3. Coverage Requirements

- According to state laws, insurance plans must cover the diagnosis and treatment of infertility, including IVF.

- This covers the cost of diagnostic tests, surgical procedures, prescription pharmaceuticals, and medications used in fertility treatment.

- The regulations also require insurance companies to cover up to four egg retrievals and three embryo transfers per lifetime.

4. Limitations and Exclusions

- Despite state laws, there are still limitations and exclusions in California IVF insurance coverage.

- Some insurance policies may not cover all components of IVF treatment, while others may limit the number of treatments available.

- Additionally, some insurance policies may not cover some infertility diagnoses or certain therapies completely.

To choose the appropriate course of action for their needs, it is crucial for couples to understand the restrictions and exclusions of their insurance plan and to talk about these with their insurance provider and fertility doctor.