懷孕保險： means pregnant insurance
我們在此跟大家分享一個令人振奮的消息，這讓紐約州的許多低收入兒童更能負擔得起醫療保健保險。
從 2022 年 10 月 1 日起，已取消對參加 Child Health Plus (CHPlus) 計劃的兒童（收入在聯邦貧困線的 160% 至 222% 之間的家庭）的 9 美元家庭保費。
這一變化影響了大約 146,000 名兒童 目前已加入該計劃。這意味著有這麼多名兒童的家庭受惠！
如果你是在 8 月 16 日或 17 日申請的兒童保健計劃，此變化將體現在10月1日。
下方截圖是新的 2022 聯邦貧困線 FPL 圖表和 CHPlus 的月費相關資訊：
确保孕期时的健康，能够令生孩子的过程更加顺利，准妈妈们需要选好自己的妇产科医生（OB/GYN），定期做孕期检查（Prenatal Care）。
如果你已经升级为准妈妈，尤其是第一次怀孕的话，可能会好奇在美国怀孕要买什么保险？怎样选OB？怎样预约产检？常常听说的OB、Midwife、Doula又是什么意思？有什么不同？
不少人都被美国的天价医疗费用吓怕过，拥有一份可以报销怀孕产检（Prenatal Care）、生孩子（Labor & Delivery）、新生儿护理（Newborn Care）等医疗费用的医疗保险非常重要。如果你已经有医疗保险，要打保险卡上的客服电话，跟保险公司确认自己的保险计划是否包含Maternity Benefits，能报销多少，网内有哪些诊所及医院选择等。
美国医疗保险有不少种类，而可以报销生孩子相关医疗费用的医疗保险，属于Major Health Insurance（主要医疗保险）。一般情况下，必须要在每年11月1日至12月15日（Open Enrollment Period）期间才能登记购买第二年的保险计划。除非有特殊情况，例如雇主提供的医疗保险福利一般属于group insurace（集体保险），不受这个时间限制。
另外，有Special Life Event（特殊生活事件）的话也可以即时购买主要医疗保险计划，而不受开放注册期的限制，例如：
如果实在买不到，低收入人士还可以考虑申请Medicaid，中文俗称白卡的美国医疗补助福利。美国现在有很多州，对于怀孕妇女申请紧急白卡并没有公民或绿卡的身份限制，而且以现时的政策来说，仅使用怀孕时期的白卡福利不会算作公共负担。
妇产科的英文是Obstetrics and gynaecology，简称OB/GYN（缩写就直读字母的发音“oh-bee-gee-why-en”），OB可以指obstetrics（产科）或者obstetrician（产科医生），同理GYN可以指gynaecology（妇科）或者gynecologist（妇科医生）。所以准妈妈们如果想给自己找一个专业负责产检以及接生的医生的话，就要找OB/GYN啦！
在美国，OB/GYN大多时候属于“specialist（专科）”，但有些保险也将OB/GYN当“primary care provider（简称PCP，家庭医生）”。如果保险将OB/GYN当作专科看待，那么预约OB/GYN之前，可能还需要先得到PCP的“referral”，没有referral就去看专科，保险有可能会拒绝报销哦。
除了OB/GYN以外，部分Family Medicine Physician（家庭医生的一类）也可以为孕妇做产检和接生，如果准妈妈本来的家庭医生是family doctor，也可以不换医生，但大多数family doctor不能做剖腹产手术。
为了避免不必要的麻烦，小伙伴们最好在预约OB/GYN之前，先打医疗保险客服电话，问清楚自己的保险福利，比如：
在保险网内选医生时，也应该先向诊所咨询清楚，该医生是否愿意接孕妇的个案（说明预约原因的时候诊所可能就会告诉你某某医生现在不接这种案子了）。因为做产科医生基本上就是24小时on call，病人什么时候有疑问、或者要生了，医生都要随叫随到，比较劳累，所以部分OB/GYN虽然还挂着这个科目的头衔，但并不一定愿意接帮孕妇产检和接生的案子。
在美国，绝大多数OB/GYN平时是在诊所（Clinic）里做普通产检，最后会在固定的大医院（Hospital）里接生。考虑医生所在诊所和医院的距离，交通便利也是很重要的，孕初期可能不觉得，但到孕后期、临盆的时候就肯定是希望路程不要太远了。除了诊所，准妈妈们也要考虑大医院的环境设备、还有医院方面的收费、保险报销和自付费用的计算，医院收费通常跟OB/GYN收费是分开的。
想要找个好医生，当然要先花点精神做功课。问身边人的推荐、搜索医生或者诊所在网络上的评价、看同城的家长论坛等等，都可以给你一个大致的选择方向。
因为准妈妈很多时候精神会比较紧张，尤其是第一次怀孕各种各样的问题也会特别多，有一位耐心的主诊医生很重要。问清楚医生会不会24 hour on-call? 诊所有没有 24×7 hotline，可以随时回应自己的问题。如果分娩时主诊医生刚好有事不在的话，会有什么应对方法？如果准妈妈本身患有某些疾病的话，最好也能先了解哪个医生对于这类特殊情况更有经验再决定。
选好医生之后还是可以更改的，通常第一次见医生的时候都会用比较长时间来交流彼此对生孩子的意见，比如在某些情况下选择顺产还是剖腹产之类，如果发觉医生的理念跟你的有不一样的话，可能还是尽早换个医生更好。
在美国生孩子，可以选择的医护人员并不仅仅只有OB/GYN或者family doctor，你可能还会听到Midwife（助产士）这个名词。
Midwife，主要分为 “Certified Nurse Midwife”（简称CNM，认证护士助产士）、“Certified Midwife”（简称CM）和“Certified Professional Midwife” （简称CPM）三类。CNM最常见，本身是注册护士，并且额外接受助产士教育认证委员会（ACME）的专业课程培训以及通过美国助产士认证委员会（AMCB）考证；CN是没有护士资格但同样通过ACME课程及AMCB考证；CPM则是由北美助产士登记处（NARM）认证的助产士。
CNM和CN通常会在医院或者分娩中心帮忙接生，即使你本身的主诊医生是OB/GYN，在医院分娩的时候通常也会有其他midwife来帮忙；而CPM则主要在分娩中心或者孕妇家中帮忙接生。
Midwife能提供跟OB/GYN一样的、非手术性的妇科和产科服务。也就是说，如果准妈妈的健康状况不复杂、低风险、可以顺产的话，midwife也完全可以负责从产检到接生的全套服务。
相比起OB/GYN，midwife通常有更多的时间来陪伴孕妇，在孕妇分娩的时候也大多能全程跟随，OB/GYN通常比较忙，宫缩阵痛的时候可能只是定点来检查，到最后真正要生了的时候才会一直在。midwife也对使用自然方法来减少分娩时的宫缩阵痛更在行，比如会建议通过水浴、不同的姿势等等非药物方式来舒缓阵痛。
Midwife通常都会和对应的OB/GYN合作，如果midwife在产检过程中发觉准妈妈的健康情况有变，也会将准妈妈的个案转到可以处理更复杂问题、能操作剖腹产的OB/GYN那里。
除了OB/GYN以及midwife以外，doula也是准妈妈们很可能会接触到的一类职业陪护人员。
Doula是陪产士，主要分为birth doula（分娩陪伴）和postpartum doula（产后陪伴）两种。Doula不属于医疗人员，她的角色更类似于扮演孕妇和产妇们的知心好友，比如在准妈妈分娩的时候陪她说话、帮她按摩、提醒她呼吸等等来帮孕妇放松心情。如果说OB/GYN和midwife能提供更多生理健康方面的帮助，那doula则是主要帮助妈妈们保持良好的心理健康。
有研究表明，请doula陪伴分娩有利于妈妈自然分娩更快更顺利，能减少使用药物来镇痛的几率，减少剖腹产的几率，让孕妇的分娩过程更加舒心，甚至能提高宝宝健康状态。
由于doula不是正式医护人员，所以医疗保险可能不能报销请doula的费用（但问问也没坏，或者能报呢）。另一方面，由于考doula认证的过程需要有很多实习积累，所以也可能会有实习中的doula愿意降低收费甚至免费做义工。准妈妈们有兴趣的话，也可以向自己的主诊医生打听一下这方面的信息。
在美国生孩子，除了可以选择在大医院里分娩以外，还可以选择在Birthing Center（分娩中心）里分娩。另外在部分地区，预约助产士来家中帮忙接生也是可以的，但美国妇产科医师学会（ACOG）并不推荐Homebirth选项。
前面提到，选择OB/GYN的时候通常会在诊所里做产检，最后会到相应的大医院里分娩。美国大医院里通常都会提供独立的产房，配套各种检查仪器，可以提供各种分娩所需的医疗用品，有各类专业的医护人员在旁服务。而且大楼内也有手术室准备，万一需要剖腹产，也可以马上转过去。
妈妈在医院生产后，通常也可以享有独立的育婴房，里面会配置妈妈休息的病床，新生儿睡篮，有沙发床可供爸爸或其他陪护家人过夜休息。新生儿所需的尿片、配方奶、打包巾等等日常用品，医院通常也都会直接提供。绝大部分的新生儿的检查护理，都可以直接在育婴房里进行，妈妈也可以利用这段时间多向驻站的医生护士请教。
大多数医院都可以免费安排参观产房（Labor & Delivery Tour / Maternity Tour），让准爸妈们了解将来在医院生孩子的流程，医院的相关政策（比如拍摄录影），医院到时会提供的设施、用品及服务等等。准爸妈们记得一定要跟医院预约参观哦。
分娩中心则是另一类有专业医护人员（以midwife为主）驻站、专门为孕妇自然分娩提供的场所，里面的房间设施会更有家的亲切感，让准妈妈能够更加放松。
大多数分娩中心的房间里会有双人大床、按摩浴缸等类似豪华酒店的设施，提供的餐饮选择可能也会更多更好，另外如果准妈妈想要选择Water Birth（水中分娩）这样的分娩方式的话，可能就要选择在分娩中心这种机构才行了，一般的OB/GYN和大医院并不会提供这类选择。
但是分娩中心通常也没有Epidural（硬膜外麻醉）之类需要由专业麻醉师（Anesthetist）操作的无痛选项，midwife会通过其他自然方式来帮孕妇减痛和放松。
正规的分娩中心里也会有设定好的备用方案，比如万一出现紧急状况，孕妇就会被转送到最近的医院由更专业的OB/GYN来接手。所以想要保险一点的话，选择紧靠大医院的分娩中心会更好。
由于分娩中心提供的通常是比较简单的自然分娩服务，比起医院来说，或许能花更少的钱获得更舒适的生孩子体验，但是价钱这方面还是主要看具体机构收费以及保险报销的差异。如果准爸妈们想要考虑选择在分娩中心生宝宝的话，可以在CABC（分娩中心认证委员会）官网查询附近认证的Birth Center。爸爸妈妈也可以先预约参观分娩中心再决定。
怀孕并不是生病，大多数情况下胎儿都能健健康康顺顺利利的诞生，并不会遇到什么大问题，合资格的midwife和birth center已经足够保证准妈妈们健康顺利分娩，健康风险低的准妈妈们也可以有更多可靠的选择。
前面提到，医院跟分娩中心的其中一个差别是无痛分娩的选项。在大医院分娩的话，孕妇可以选择需要由麻醉师操作的无痛分娩，例如最常用的Epidural（硬膜外麻醉）或者Spinal Block（腰麻）等局部麻醉方式。
简单来说，Epidural是由麻醉师在腰部插管子，通过连续输液的方式来输送麻药，通常需要10-20分钟才能起效，但之后孕妇可以按照自己的感觉来加减麻药分量（输液速度）。Spinal block则是由麻醉师在腰部打一针麻药，很快就能起效，但持续时间只有1~2小时，所以更常用于剖腹产。
个人经验是，如果你比较怕痛，当护士问你是否需要无痛的时候最好赶紧答应了，因为麻醉师也不是随时都有空的！！！如果等到你痛得不行的时候再让上无痛，而麻醉师刚好又有其他事情做，拖上一段时间才来，可能就会比较惨。因为无论在腰部打针或者输液都必须要孕妇保持不动的姿势，但如果你已经很痛了，可能根本就没有办法控制身体的抖动…就会拖上更长时间…（嗯，这是惨痛教训得来的经验）
噢，麻醉师的账单也是跟产检分开算的（会算在医院部分），别忘记了解一下关于麻醉方面的保险报销的问题。
由于两次怀孕都纯属意外，之前并没有做过备孕准备（Preconception Care，想要备孕的小伙伴们也可以预约医生看这个），所以就说说这种知道了自己怀孕才去联系OB/GYN的经验吧。
市面上有不少准确度很高的验孕棒和验孕试纸，怀疑自己怀孕了的话可以到药房买来测一下，像Walmart 这样的超市药房就有卖，在非处方的货架上，比如Clear Blue的，能清晰显示“Pregant/Not Pregnant’”或者“+/-”，结果直接明了，不用怕传统试纸那样显示不清晰，一杠还是两杠全靠猜。
只要验孕棒显示阳性，就可以联系保险网内的OBGYN预约做检查。
预约第一次去产检的时候，电话里登记了保险，最后一次经期等信息，然后接线员就帮忙定了ultrasound（B超）和见OB两个连续的appointment。
第一次去诊所的时候最先去见了business department（负责收费的部门）的人，这个步骤是确认保险报销费用以及我要自付的费用，工作人员跟我说我的保险产检所有费用（包括超声波、验血、验尿、医生检查等等）全包，生孩子的费用（无论顺产还是剖腹产）也全包，但是由于分娩是在大医院里，使用医院设施、在医院留院的费用是由医院另外收取的，他们不负责，需要额外交多少费用要我自己联系医院问。
而医院部分则是按照“in-patient”住院那样的情况来收费和报保险，如果分娩时需要麻醉和剖腹产，就会有额外的麻醉和手术相关费用。另外留院期间宝宝也要做一些检查和打疫苗，这部分也是额外收费，而且in-patient和newborn care福利跟maternity福利是分开计算的，即使maternity care报销100%，但in patient和newborn care通常不是，而且还需要先付够deductible保险才帮忙报销。
个人觉得美国人对于怀孕并没有中国人那么“紧张”，如果没有特殊情况的话，产检很轻松，甚至可能给人一种“医生好像根本都不重视”的错觉。据说中国的医生只要是怀孕了就会让孕妇补这补那的开始保胎程序，而美国医生基本上不会，即使是前三个月的危险期，医生也是一副顺其自然的做派。
美国医生一般认为孕初期时流产是因为胎儿本身发育有缺陷，是自然淘汰，强行保胎对于胎儿将来的健康未必是好事。一般除非是孕妇之前有过小产经历的才会做一些特别措施来保胎。
谢谢大家耐心看完全文，欢迎来分享自己的怀孕产检心得，或者带坐标分享一下当地口碑好的医院、医生，好用的医疗保险，让更多的新朋友们可以受惠。大家有任何疑问、建议或意见都欢迎提出来。
另外，美国各州都会有政府资助的孕妇产检援助项目，妈妈们有需要的话，可以拨打电话：800-311-BABY (800-311-2229) 查询。
J-1签证是美国签发给前往该国进行教育、艺术以及科学方面学术交流人士的签证，即交流访问学者签证，为非移民签证。和其他非移民签证不同，持美国交流访问学者签证入美国的人有特殊的212(e)回国服务两年的限制。
即访问结束后，必需回到原申请国，住上两年或申请豁免。相对而言美国交流访问学者签证最大的优点是家属的J-2签证在美国有比较大的自由。大中华地区的申请者均可获得有效期最多为五年的年签证。
F1签证是指到美国就读中学的学生签证，期限根据学生在学校的学习时间而定。 该签证是签发给在美国政府认可的全日制学校就读的外国学生的一种签证；
F1签证可以之后工作，J1不可以工作。 所以通俗来说J1就是交换或者交流的签证，F1是留学的签证。
已经怀孕，属于 pre-existing condition（已有狀況），保险公司都不想管，原因很简单：必然亏钱的生意，谁乐意做？奥巴马总统任内立法，要求 healthcare.gov 的保险计划不得因 pre-existing condition 而拒绝病人投保，然而这通常只适用于美国公民和永久居民，不适用于访客。
短期保險/旅遊保險通常都不覆蓋已经怀孕者的生育，哪些所谓「孕中险」通常只是覆蓋怀孕过程中出现的意外和并发症，并不覆蓋正常生产的费用。
如果你要来美国旅游、留学、进修、短期交换，并想趁这个机会在美国生孩子，最好提前计划，不要等到已经怀孕了才考虑保险的问题。如果是J2签证已经怀孕了，可以考虑：
若 J-1 是美方出钱、而不是中方出钱，他／她的保险有可能和普通美国居民一样，那样的话会覆蓋已经怀孕的情形。
即使 J1 是中方出钱，也可问问美方，看能否通过他们给配偶购买已经怀孕的保险。
J-2可以申请工作许可。若 J2 能找到一份全职工作，也许能通过雇主购买此类保险。
當然，這只是根據大部分情況來說，也會有特殊情況。歡迎與我們聯繫溝通。
更多關於懷孕生子的信息可點擊此處查閱
如果你尚未懷孕，又不想使用補助計劃/白卡的話，可點擊此處查詢全價自費PPO保險計劃
但如果你已經懷孕，又無法承擔昂貴的醫療費用，可以考慮申請白卡補助計劃，此行為屬特殊情況，應該不會被當做“公共負擔”
如需了解可幫助你申請白卡的機構或一些關於低收入補助/福利資訊，請點擊此處查看。
很多人都十分關心這個問題，正因為擔心帶來不良影響，所以大家都不敢輕易使用政府補助計劃。
但在這裡，我們可以肯定地告訴你，如果你經濟負擔得起，然而只是為了省錢，而濫用白卡的話，是一定會影響到你之後再次入境美國申請的。
所以希望大家都能在來美之前計劃好一切，包括找到合適自己的醫療保險，一旦到了美國才懷孕的，就很難找到保險公司願意承保你的案子了。
IVF醫療保險，IVF醫療保險由醫療保險承保，並且從2020年1月1日開始，如果您在一家擁有100名員工或以上的公司工作，就可以享受此項福利。
對於較小的團體（即少於100人的公司），您的保險可能會涵蓋I.U.I.
但在現金社會，每個人都不得不為口奔馳，面對每天如此繁忙的工作，緊張的生活節奏，導致很多人都錯過了生育的黃金時機。正如本人，所以我清楚知道40歲前是生育最關鍵的時刻！
本人曾經在幾年前，大概是2015年的時候咨詢過長島的醫生關於人工受孕的事情，當時得到的信息是，他們有提供一種3萬多美元的套餐，就是說包生孩子，一直讓你嘗試到能成功懷上為止。當然這也已經是幾年前的價格，相信現在應該更貴一點。
而我也有個朋友在那些不孕不育的公司上班，她的醫生是常春藤名校畢業的，從他那裡得知的價格是4萬多美元了！
寫這篇文章的主要原因是，我們每個月都有接到好幾個客人是咨詢關於生育問題的，他們都想知道如何可以用保險來覆蓋人工受孕IVF (In vitro fertilization)
在過去多年來，我們也有提供資訊，有些保險公司會提供IUI (Intrauterine insemination)，這是一種俗稱“生仔針”的藥物，可以大大提高懷孕的可能性，不過這支神奇的針價值不菲哦，需要幾千美元打一針。這對很多人來說，也不是容易接受的。
但新喜訊是，從2020年1月1日起，大型團體/公司（100人以上），政府要求其醫療保險需覆蓋3次嘗試人工受孕的費用。
如果按照一次2.5萬來算（相當於一輛小車的價格），那些能用得上這三次機會的女士，就等於免費有了三輛小車了。
IUI和IVF治療之間的主要區別是：IVF是一個涉及卵子刺激，取回，受精和轉移的過程。 IUI將精子注入子宮，以減少精子到達卵子的時間。 將產生的胚胎轉移到子宮中。
2020年國家預算中頒布的新法律規定，某些大型團體（100人以上）保險計劃必須涵蓋IVF，並要求所有私人保險公司承擔醫療必需的卵子冷凍。
《可負擔醫療法案》由於州法律的怪異，要求紐約承擔中小型計劃的任務。
紐約是治療IVF患者最昂貴的州之一，因為單個IVF週期的平均費用為24,000美元。根據我們的數據，只有不到38％的紐約州居民擁有涵蓋IVF相關費用的保險單，因此大多數患者完全自掏腰包。
曾幾何時，很多人會考慮能否負擔得起IVF這般昂貴的費用。但現在在新政策的規定下，大家只需盡量爭取能去大公司上班（大公司的定義是員工多於100人），就能省下一大筆費用了。
而少於100人的小型公司，政府規定的是其醫療保險需要覆蓋冷凍卵子的費用。
原則上來說是可以的，人工受孕是可以決定孩子的性別，但請記得我們只是醫療保險代理人，並非醫生，所以請和相關專業人士確認。
但以我們自己的理解，關於選擇性別的費用是不包含在醫療保險計劃中的，意味著需要額外的費用。
下方我們也有提供現在最新的醫療保險公司所覆蓋的準則。
* 如果有人願意幫忙翻譯下文內容，我們可以把你的署名放在此文章中，以幫助到有需要人士。
In this Aug. 11, 2008, file photo, a scientist works during an IVF process. A new law, enacted in the 2020 New York state budget, mandates that certain large-group insurance plans cover IVF, and requires all private insurance companies to cover medically necessary egg freezing. (AP Photo/PA, Ben Birchall, File)
ALBANY — With more young women and men delaying parenthood, the demand for fertility treatments such as egg freezing and in-vitro fertilization (IVF) has grown across the country.
Legislation and science have lagged behind the trend, and the cost of the treatments can be prohibitively expensive.
A new law, enacted in the 2020 state budget, mandates that certain large-group insurance plans cover IVF, and requires all private insurance companies to cover medically necessary egg freezing.
It is projected to benefit to up to 2.4 million New Yorkers, according to figures from Gov. Andrew M. Cuomo’s administration, but there are kinks to iron out before it guarantees coverage to the other half of insured New Yorkers, including gay men, Medicaid-recipients, and the self-employed.
Secretary to the Governor Melissa DeRosa, the first woman to hold that position, pushed for IVF legislation in the spending plan, citing it as a top priority for the two-year-old Council for Women and Girls.
DeRosa, 36, said that she understands the anxiety of women in her age group who are pressured to decide between advancing their careers and starting a family.
“There is nothing more personal or life altering than the ability to conceive and making the choice about when to conceive,” DeRosa said. “As someone who is currently facing these life-altering decisions, I know firsthand the toll they take — emotionally and financially.”
Last year, Cuomo directed the state Department of Financial Services to study the cost of implementing an insurance mandate on egg freezing and IVF.
The report, released to the public in February, suggests that mandating all insurances cover those costs would be too expensive for the state. The Affordable Care Act, due to a quirk in state law, requires New York to absorb mandates on small and medium sized plans.
“Limiting an IVF mandated benefit to large group insurance policies mitigates that premium impact and avoids a state fiscal risk,” according to the DFS report.
Ten states have IVF insurance coverage laws, according to the DFS study, but most include limits on funding, number of cycles, age, and other restrictions.
In addition, providing access to treatment for thousands of New Yorkers, the bill is “finally a recognition that infertility is a disease, not a lifestyle choice,” said Barbara Collura, President & CEO of RESOLVE: The National Infertility Association. “Quite honestly, having New York do it is going to be a game-changer for the rest of the country.”
Highlights of the new law:
What type of plans must offer coverage?
Large insurance plans, providing coverage to 100 employees or more, must cover in-vitro treatments and associated medications and testing.
Employees of small and medium-sized companies, companies that self-insure, and those with individual insurance plans are not guaranteed coverage. Approximately half of New Yorkers with health insurance would qualify for the benefit, according to DFS.
How many cycles of IVF are covered?
Three.
Are their age restrictions?
No. New York’s law gives the doctor discretion to consider the patient’s age when deciding if she is an appropriate candidate for IVF.
What about egg freezing?
The new mandate requires all insurance plans cover cryogenic egg freezing for medically necessary purposes. Women undergoing chemotherapy for cancer are often offered the opportunity to freeze their eggs, but decline when they learn of the cost, according to the DFS report.
Other qualifying procedures include sex-reassignment surgery, sickle cell anemia, bone marrow transplant, or surgery for endometriosis.
Is surrogacy covered under this plan?
No. Currently, surrogacy is illegal in New York.
Insurers are also not mandated to cover the healthcare of a person outside the family unit.
Sen. Brad Hoylman, D-Manhattan, and Assemblywoman Amy Paulin, D-Westchester, have introduced legislation updating the state’s surrogacy laws. If it passes, the issue will be revisited.
“We want to probably seek some guidance from the Department of Health … and work with experts in making certain that the bill is carefully crafted,” Hoylman said.
Are single women and gay and lesbian couples covered under the plan?
Single women and lesbians are covered. For gay men, it’s complicated.
IVF mandates in other states have excluded gay and lesbian couples due to narrow medical definitions of infertility. Anti-discrimination language in the bill prohibits discrimination based on marital status, age, sexual orientation or gender identity, and broadens that definition.
Infertility, according to the bill, is a condition characterized by an inability to conceive “after 12 months of regular, unprotected sexual intercourse or donor insemination.” For women above the age of 35, the requirement is six months of regular, unprotected sexual intercourse or donor insemination without conception.
Figuring out how to extend the benefit to male couples, who can only conceive through an out-of-state surrogate, has not been worked out, according to Hoylman.
“The issue is, for example, a gay couple who is seeking a donor egg, whether fertilizing the egg in the transfer would be covered,” Hoylman said. “I’ll be looking at the language to strengthen it.”
What other programs are out there to assist with fertility treatments?
In 2003, the state’s Infertility Demonstration Program was created to subsidize the cost of fertility treatments for employed New Yorkers. Grants are available on a sliding scale, based on income for families earning up to $195,000.
To qualify, patients must be between the ages of 21 and 44 years and have private health insurance (not Medicaid, Medicare, or Family Health Plus).
We Cover services for the diagnosis and treatment (surgical and medical) of infertility. “Infertility” is a
disease or condition characterized by the incapacity to impregnate another person or to conceive, defined
by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse
or therapeutic donor insemination, or after six (6) months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older. Earlier evaluation and treatment
may be warranted based on a Member’s medical history or physical findings. Such Coverage is available
as follows:
1. Basic Infertility Services. Basic infertility services will be provided to a Subscriber who is an
appropriate candidate for infertility treatment. In order to determine eligibility, We will use guidelines
established by the American College of Obstetricians and Gynecologists, the American Society for
Reproductive Medicine, and the State of New York.
Basic infertility services include:
• Initial evaluation;
• Semen analysis;
• Laboratory evaluation;
• Evaluation of ovulatory function;
• Postcoital test;
• Endometrial biopsy;
• Pelvic ultrasound;
• Hysterosalpingogram;
• Sono-histogram;
• Testis biopsy;
• Blood tests; and
• Medically appropriate treatment of ovulatory dysfunction.
Additional tests may be Covered if the tests are determined to be Medically Necessary.
2. Comprehensive Infertility Services. If the basic infertility services do not result in increased fertility,
We Cover comprehensive infertility services.
Comprehensive infertility services include:
• Ovulation induction and monitoring;
• Pelvic ultrasound;
• Artificial insemination;
• Hysteroscopy;
• Laparoscopy; and
• Laparotomy.
3. Fertility Preservation Services. We Cover standard fertility preservation services when a medical treatment will directly or indirectly lead to iatrogenic infertility. Standard fertility preservation services include the collecting, preserving, and storing of ova, sperm or embryos. “Iatrogenic infertility” means
an impairment of Your fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.
4. Exclusions and Limitations. We do not Cover:
• In vitro fertilization; • Gamete intra-fallopian tube transfers or zygote intra-fallopian tube transfers;
• Costs for an ovum donor or donor sperm;
• Sperm and ova storage costs except when performed as fertility preservation services;
• Cryopreservation and storage of embryos;
• Ovulation predictor kits;
• Reversal of tubal ligations;
• Reversal of vasectomies;
• Costs for and relating to surrogate motherhood;
• Cloning; or
• Medical and surgical procedures that are experimental or investigational, unless Our denial is
overturned by an External Appeal Agent.
All services must be provided by Providers who are qualified to provide such services in accordance
with the guidelines established and adopted by the American Society for Reproductive Medicine. We will
not discriminate based on Your expected length of life, present or predicted disability, degree of medical
dependency, perceived quality of life, other health conditions, or based on personal characteristics
including age, sex, sexual orientation, marital status or gender identity, when determining coverage under this benefit.
We Cover services for the diagnosis and treatment (surgical and medical) of infertility when such infertility is the result of malformation, disease or dysfunction. Such Coverage is available as follows:
1. Basic Infertility Services. Basic infertility services will be provided to a Member who is an appropriate candidate for infertility treatment. In order to determine eligibility, We will use guidelines established by the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, and the State of New York. However, Members must be between the ages of 21 and 44 (inclusive) in order to be considered a candidate for these services.
Basic infertility services include:
• Initial evaluation;
• Semen analysis;
• Laboratory evaluation;
• Evaluation of ovulatory function;
• Postcoital test;
• Endometrial biopsy;
• Pelvic ultra sound;
• Hysterosalpingogram;
• Sono-hystogram;
• Testis biopsy;
• Blood tests; and
• Medically appropriate treatment of ovulatory dysfunction.
Additional tests may be Covered if the tests are determined to be Medically Necessary.
2. Comprehensive Infertility Services. If the basic infertility services do not result in increased fertility, We Cover comprehensive infertility services.
Comprehensive infertility services include:
• Ovulation induction and monitoring;
• Pelvic ultra sound;
• Artificial insemination;
• Hysteroscopy;
• Laparoscopy; and
• Laparotomy.
3. Exclusions and Limitations. We do not Cover:
• In vitro fertilization, gamete intrafallopian tube transfers or zygote intrafallopian tube transfers;
• Costs for an ovum donor or donor sperm;
• Sperm storage costs;
• Cryopreservation and storage of embryos;
• Ovulation predictor kits;
• Reversal of tubal ligations;
• Reversal of vasectomies;
• Costs for and relating to surrogate motherhood (maternity services are Covered for Members acting as surrogate mothers);
• Cloning; or
• Medical and surgical procedures that are experimental or investigational, unless Our denial is overturned by an External Appeal Agent.
All services must be provided by Providers who are qualified to provide such services in accordance with the guidelines established and adopted by the American Society for Reproductive Medicine.
L. Infusion Therapy.
We Cover infusion therapy which is the administration of drugs using specialized delivery systems that otherwise would have required You to be hospitalized. Drugs or nutrients administered directly into the veins are considered infusion therapy. Drugs taken by mouth or self-injected are not considered infusion therapy. The services must be ordered by a physician or other authorized Health Care Professional and provided in an office or by an agency licensed or certified to provide infusion therapy. Any visits for home infusion therapy count toward Your home health care visit limit.
The Arkansas infertility mandate, enacted in 1987, requires at least $ 15,000-lifetime coverage for IVF (In Vitro Fertilization) treatment for infertility provided a woman’s eggs are fertilized by her husband’s sperm.
California law requires insurers to offer infertility benefits to employers as an additional rider when they purchase their yearly insurance benefits. If your current employer does not offer infertility as part of your benefits package, this could be an area you could influence future benefits decisions
The State of Connecticut passed a bill in 2005 which passed breakthrough legislation that requires most insurance companies to cover infertility diagnosis and treatment. … As of January 01, 2016 insurance carriers are required to remove the age limit on infertility benefits and policies.
The Hawaii infertility mandate, enacted in 1989, requires any fertility coverage, including a single IVF cycle, in any plan that also provides maternity coverage for couples who have been trying unsuccessfully to conceive for 5 years or who have been diagnosed with a condition known to cause infertility.
The state of Illinois passed the Family Building Act in 1991. In short, it requires group health insurance plans that cover more than 25 employees to cover the diagnosis and treatment of infertility up to and including 4 IVF attempts (egg retrieval procedures).
Know your rights: The Louisiana Infertility Mandate. The Louisiana infertility mandate, enacted in 2002, makes it illegal to exclude coverage for a medical condition just because it results in infertility. It does not require coverage for fertility drugs, treatments or sterilization (getting vasectomy or tubes tied).
This handout describes the Mandatory Benefits that may be contained in your contract if you have coverage through a large group (groups of more than 50 employees) health benefit plan or are in a grandfathered plan. (Your plan is a grandfathered plan if you were in a plan on or prior to March 23, 2010, and the plan has not substantially changed.)
The Massachusetts infertility mandate, enacted in 1987, is hailed as one of the most comprehensive in the country by requiring infertility be treated like any other medical condition and not mandating a cap on coverage (either in the number of cycles or a lifetime dollar amount).
The Montana infertility mandate, enacted in 1987, requires HMOs to provide coverage for “infertility services” as a basic health care service that must be covered but it doesn’t define infertility or which services must be covered.
New Jersey mandate for infertility coverage. … The insurance mandate states that any insurance provider who provides pregnancy-related benefits must also cover infertility treatment and IVF costs. The law also requires health plans contracting to cover state employees and teachers to include the same infertility coverage
The Ohio infertility mandate requires health maintenance organizations (HMOs) to provide basic health services, which includes infertility care, when medically necessary. A bulletin released by the department of insurance clarifies that IVF and other forms of assisted reproduction are outside of the scope of the law.
The Rhode Island insurance mandate states that insurance must provide coverage for medically necessary expenses for the diagnosis and treatment of infertility, which can include in vitro fertilization (IVF). But, the amount of coverage can vary from plan to plan.
Texas state law requires certain insurers that cover pregnancy services to offer coverage for in vitro fertilization (IVF insurance benefits). … However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans.
West Virginia’s law requires health maintenance organizations to cover basic health care services, including infertility services, when medically necessary.