Advocacy

From our earliest days of helping to pass the landmark infertility insurance mandate in Massachusetts in 1987 to our ongoing efforts to advocate for access to care, Resolve New England (RNE) has demonstrated a deep commitment to advocating for the fertility community.

RNE advocates in every New England state, actively supporting legislation that will be positive for fertility and family building, while other times actively opposing legislation that would prove a threat. Five of the six states in the region have passed fertility insurance laws. We are determined to make this six out of six, as well as to doing the ongoing work to protect access to fertility care and family building for all New Englanders. If you have questions about fertility coverage in your state or are having problems accessing care, please contact RNE Director Kate LeBlanc so that we can try to help!

RNE also proudly joins our national partners in advocating for fertility and family building at the federal level.

Overview of Existing Laws

Connecticut

Learn about RNE’s current advocacy work in Connecticut.

Connecticut Fertility Insurance

Yes, Connecticut has a Fertility Insurance Law. It passed in 1989 and has been amended several times. RNE is an active member of the Fertility Access CT (FACT) Campaign, advocating for improvements to the current statute.

Summary

The Connecticut Fertility Insurance Law provides coverage for:

  • Infertility diagnosis and treatment for individuals
  • Medically necessary fertility preservation

Legal Definition of Infertility

The Act defines infertility as “the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary.”

Limits

This mandate does limit lifetime maximum coverage for ovulation induction (4 cycles), intrauterine insemination (3 cycles), and IVF, GIFT, ZIFT or low tubal ovum transfer (2 cycles). Treatment must be performed at fertility clinics that conform to the guidelines developed by the American Society of Reproductive Medicine (ASRM) and the Society of Reproductive Endocrinology and Infertility (SREI).

Exemptions

Religious employers and employers who self-insured are exempt from the Connecticut insurance mandate requirements. For more information about the Connecticut Insurance Mandate, please consult Chapter 700c-38a-509 and BULLETIN HC-125.

Maine

Learn about RNE’s current advocacy work in Maine.

Maine Fertility Insurance

Yes, Maine just passed a Fertility Insurance Law in May 2022.

FAQs

Am I covered by the new fertility insurance law?

First, ask your employer if your health plan is “self-insured” or “fully insured”. Unfortunately, self-insured employers do not NEED to follow state mandates (some choose to do so voluntarily). If fully insured, you need to confirm with your employer/insurer that it is a Maine-based plan.

When will coverage take effect?

You should check or ask your employer or insurer if you have an individual or group plan. If you have a group plan, the new coverage requirements go into effect when your plan is renewed (this date varies plan-to-plan and may not be January 1st). For individual plans, the new requirement is in effect on January 1, 2024.

What is covered?

As of February 2024, the Maine Bureau of Insurance has not issued the final Rule for the fertility insurance law. The Rule outlines more specifics about the coverage. Until these are finalized, insurers are developing interim coverage.


Please
contact Kate if you have questions or problems related to accessing fertility coverage, or if you want to get more involved in advocacy in Maine. Thank you!

Massachusetts

Learn about RNE’s current advocacy work in Massachusetts.

Massachusetts Fertility Insurance

Yes, Massachusetts has a Fertility Insurance Law. It passed in 1987 and was amended in 2010.

Summary

The Massachusetts Fertility Insurance Law provides coverage for:

  • Infertility diagnosis and treatment for individuals

Legal Definition of Infertility

“Infertility” shall mean the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35.

Additional Definitions

For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1 year or 6 month period, as applicable.

Limits

No insurer shall be required to provide benefits for any experimental infertility procedure, until the procedure becomes recognized as non-experimental and is so recognized by the Commissioner; reversal of Voluntary Sterilization; cryopreservation of eggs. These procedures are at the optional coverage discretion of the individual insurance provider.

Exemptions

Employers who self-insured are exempt from the Massachusetts insurance mandate requirements. For more information about the Massachusetts Insurance Mandate, please consult Mass Gen Laws Ann. Ch. 175, Section 47Hch. 176A, Section 8Kch. 176B, Section 4Jch. 176G, Section 4, and 211 CMR 37.00.

New Hampshire

Learn about RNE’s current advocacy work in New Hampshire.

New Hampshire Fertility Insurance

Yes, New Hampshire has a Fertility Insurance Law. It passed in August 2019 and took effect on January 1, 2020.

Summary

RSA 417-G provides group insurance coverage for:

  • Infertility diagnostics
  • Fertility treatment
  • Fertility preservation

Legal Definition of Infertility

The Act defines infertility as “a disease, caused by an illness, injury, underlying disease, or condition, where an individual’s ability to become pregnant or to carry a pregnancy to live birth is impaired, or where an individual’s ability to cause pregnancy and live birth in the individual’s partner is impaired”.

Limits

Coverage is not required for experimental fertility procedures, non-medical costs related to third-party reproduction, and reversal of voluntary sterilization. Any limitations on coverage shall be based on clinical guidelines and the enrollee’s medical history, NOT based on arbitrary factors including, but not limited to, number of attempts, dollar amount, or age.

Exemptions

Individual plans and employers who self-insured are not included in the New Hampshire insurance mandate.

Rhode Island

Learn about RNE’s current advocacy work in Rhode Island.

Rhode Island Fertility Insurance

Yes, Rhode Island has a Fertility Insurance Law. It passed in 1989 and has been amended several times.

Summary

The Rhode Island Fertility Insurance Law provides coverage for:

  • Diagnosis and treatment of infertility for women between the ages of 25-42
  • Fertility preservation

 

Legal Definition of Infertility

“Infertility” means the condition of an otherwise healthy individual who is unable to conceive or sustain a pregnancy during a period of one year.

Limits

The health insurance contract may limit coverage to a lifetime cap of $100,000.

Exemptions

Employers who self-insured are exempt from the Rhode Island insurance mandate requirements.

For more information about the Rhode Island Insurance Mandate, please consult RI Gen. Laws sections 27-18-3027-19-2327-20-20 and 27-41-33.

Vermont

Vermont Fertility Insurance

No, Vermont unfortunately does not have a Fertility Insurance Law…YET. RNE is actively advocating in Vermont this session to change that.
Learn how you can get involved!

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