In August, New Hampshire Governor Chris Sununu signed SB279 – a law that will expand insurance coverage for fertility-related diagnosis, treatment, and preservation. It’s wonderful news for many Granite State residents who wish to start a family!
For a better understanding of the benefits under this new law, we would like to provide some information for individuals and couples in their journey to parenthood.
WHEN DOES THE LAW GO INTO EFFECT?
The law takes effect on January 1, 2020, on a rolling basis as insurance policies are renewed (although many renew effective January 1st).
DOES THIS LAW APPLY TO ALL TYPES OF INSURANCE?
Not all types. While we ultimately hoped that all New Hampshire residents would receive coverage as needed, certain compromises had to be made for to the law to pass. The law applies to group health insurance plans, which are what you purchase through your employer. Individual health plans such as those purchased on the ACA Marketplace are not covered by this law.
Some NH employers offer “self-funded” health plans – which are not required to provide fertility coverage under the new mandate (a federal law prohibits NH from imposing requirements upon self-funded plans). Also exempt are two other health plans; SHOP plans and Extended Transition to Affordable Care Act Compliant Policies.
WHAT CAN YOU DO IF YOU HAVE A SELF-FUNDED PLAN THROUGH YOUR EMPLOYER?
You can ask your employer to voluntarily match the fertility care benefits under the mandate. We strongly recommend reaching out to the amazing advocates at Fertility Within Reach (www.fertilitywithinreach.org) to learn more about how to work with your employer to obtain benefits.
ARE SINGLE WOMEN COVERED BY THE LAW?
Yes, if diagnosed with infertility. The insurance companies, however, have leeway to impose pre-qualification requirements regarding “exposure to sperm” before an approval of benefits.
IS THE LGBTQ COMMUNITY COVERED BY THIS LAW?
Yes, if diagnosed with infertility. The costs of obtaining donor eggs, donor sperm, or a gestational carrier, however, are not covered.
IS DONOR EGG IVF COVERED?
The medical expenses related to donor egg treatment are covered– this includes screening, medication, monitoring, and egg retrieval. The costs of obtaining donor eggs, however, are not covered.
IS EGG OR SPERM FREEZING COVERED FOR INDIVIDUALS WITH CANCER?
Yes! Egg, sperm and embryo freezing are covered for those with a medical need! New Hampshire will become the 8th state in the nation to cover fertility preservation for those facing loss of future fertility due to medical treatments.
WHAT IF MY INSURANCE COMPANY DENIES COVERAGE FOR FERTILITY CARE?
If your insurance claim is denied, you can file an appeal. You can also file an appeal if your insurance company refuses to pre-authorize your treatment (this is something that often comes up with IUI and IVF cycles). The appeals process involves 2+ levels of appeal.
If you are seeking coverage for fertility preservation prior to chemotherapy (or have other urgent circumstances), an expedited appeal process is available. Fertility Within Reach can provide guidance on all appeal matters.
To schedule an appointment or to ask a question, please visit https://www.bostonivf.com/getting-started/ask-Rhonda-a-fertility-question/
Boston IVF would like to thank the following individuals and organizations for all their work in drafting SB279, testifying before the NH House and Senate, and making this new law a reality for individuals and couples in New Hampshire.