Maryland Expands Mandated Infertility Coverage

August 31, 2015

The Maryland General Assembly passed legislation that expands infertility coverage, including in vitro fertilization (IVF), primarily to increase coverage for same-sex married couples. The changes were effective July 1, 2015 for large medical plans issued in Maryland.

Note that small employer plans remain exempt from the IVF mandate as long as the coverage continues to be excluded from the state benchmark plan for essential health benefits. An exclusion is also available if the benefit conflicts with a religious organization’s bona fide religious beliefs and practices.

Summary of changes:

  • Same-sex couples may demonstrate infertility through 6 artificial insemination attempts that failed to result in pregnancy over a 2 year period. Previously, they could not demonstrate infertility unless it was associated with one of four listed medical conditions.
  • Coverage must now allow for the use of donor sperm for same sex couples, but does not need to cover the costs of obtaining donor sperm. However, for opposite-sex couples, coverage may still require fertilization by the spouse’s sperm.
  • Coverage for other covered infertility treatments (presumably including the 6 artificial insemination attempts noted above) also may not require that a same sex couple use the spouse’s sperm or that a same sex couple demonstrate infertility exclusively by unsuccessful heterosexual intercourse.
  • The applicable guidelines or minimum standards for medical facilities have been expanded to include those issued by the American Society for Reproductive Medicine in addition to the American College of Obstetricians and Gynecologists.

Maryland insurers are in the process of updating the Certificate or Evidence of Coverage for policies that are subject to this change. They may also send out notices to inform subscribers. If you have any questions, please contact your Keller account team.