Are you familiar with the Illinois State Mandate? If you are not, you don’t know your rights. We are very fortunate that Illinois is one of a handful of states where insurance companies are mandated to cover infertility treatment (Family Building Act, 1991). The mandate outlines all the rules and regulations for fertility coverage in IL and is worth knowing about! To summarize, you are considered infertile if you have been unable to achieve and/or sustain a viable pregnancy for one year. If you and your partner are having unprotected intercourse and can’t have a baby, you fall within the guidelines. Please note that un-reversed sterilization procedures generally disqualify you from coverage, because you are not having unprotected intercourse!
You should have insurance coverage if you
- Fall within the infertility guidelines
- Work for a company based out of Illinois
- Have more than 25 insured persons in your plan
- Have a medical condition preventing you from achieving pregnancy.
You need to check to see if your coverage is full or partial! Full coverage per the Illinois State Mandate means that you will probably be able to obtain coverage for testing, medications and treatment, including but not limited to insemination cycles and/or up to 4 in vitro fertilization (IVF) cycles. You may be eligible to receive up to two additional IVF cycles after a live birth.
Even if you do not have coverage per the Mandate, you may have limited coverage for testing and/or treatment. While in some cases this means a limited dollar amount, in others, limited coverage may still be available for you!
Additional rules and exclusions may apply. We recommend that you contact your insurance plan and your company benefit representative for additional questions.
