Clarification of Infertility Treatment Mandates

On March 19, 2019, Ins. Commissioner Mais issued Bulletin HC-125 to clarify CT’s mandated coverage for infertility treatments. In 2017, CT started to require that carriers provide coverage for medically necessary expenses of the diagnosis and treatment of infertility. This new bulletin clarifies that the harvesting of eggs and sperm is a covered benefit in cases where the patients will undergo treatment that has the potential to render them infertile. Carriers and physicians may continue to use reasonable medical management to determine if the treatment is otherwise medically necessary. The carrier may apply plan copayments deductibles, and coinsurance (range from zero to 50 percent). Male infertility treatment is covered under this mandate.

Separately, the bulletin reminds carriers of the prohibition of the use of age-benefit restrictions in the infertility treatment for policies issued or renewed on or after January 1, 2016.

Bulletin HC-125 »