Mandated Coverage for Certain Infertility Treatments

On June 30, 2018, Gov. Carney signed SB 139 into law. The new law requires group health plans to cover certain services related to fertility. Participants are eligible if they have a diagnosis of infertility or are at risk of iatrogenic infertility, which is an impairment of fertility due to surgery, radiation, chemotherapy or other medical treatment. Subscribers, spouses and non-spouse dependents are equally covered.

The law mandates coverage for sixteen identified services, including cryopreservation of eggs/sperm/embryos, storage of eggs/sperm/embryos, intrauterine insemination and embryo transfers. Coverage for in vitro fertilization (IVF) is only available to participants who have been unable to obtain a successful pregnancy through less costly treatments. Retrievals must be completed before the participant is age 45 and transfers must be completed before the participant is age 50. Plans aren’t required to provide monetary payment to surrogates or provide coverage for reversal of voluntary sterilization.

The requirement doesn’t apply to self-insured group health plans or plans maintained by employers with fewer than 50 employees. An exemption is available for religious employers for whom the coverage conflicts with their bona fide religious beliefs and practices.

The new law was effective upon the governor’s signature.

S.B. 139 »