2018 del. insurance code, title 18, sections 1, § 3342 and section 2, § 3556
infertility definition/patient requirements
- infertility refers to a disease or condition that results in impaired function of the reproductive system whereby an individual is unable to procreate or carry a pregnancy to live birth.
- iatrogenic infertility means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
- Such benefits must be provided to covered persons, including covered spouses and covered non-spouse dependents, to the same extent than other benefits related to pregnancy.
- the covered person has not been able to obtain a successful pregnancy through reasonable effort with less expensive infertility treatments covered by the policy, contract or certificate, except in the following cases:
- no more than 3 cycles of ovulation induction treatment or intrauterine inseminations may be required before IVF services are covered.
- if IVF is medically necessary, IVF services may not be required ovulation induction cycles or intrauterine inseminations before IVF services are covered. the ice is covered.
All individual, group, and general health insurance policies that cover medical or hospital expenses must include coverage for fertility care services, including standard IVF and fertility preservation services for individuals undergoing a procedure. medically necessary treatment that may cause iatrogenic infertility. Such benefits must be provided to the same extent as other pregnancy-related benefits and include the following:
- Intrauterine insemination.
- Assisted hatching.
- Cryopreservation and thawing of eggs, sperm and embryos.
- Cryopreservation of ovarian tissue.
- testicular tissue cryopreservation.
- embryo biopsy.
- consultation and diagnostic tests.
- fresh and frozen embryo transfers.
- six complete egg retrievals per lifetime, with unlimited embryo transfers in accordance with American Society for Reproductive Medicine guidelines, using single embryo (“set”) transfer when recommended and medically appropriate.
- ivf , including IVF with donor eggs, sperm or embryos, and IVF in which the embryo is transferred to a gestational carrier or surrogate.
- intracytoplasmic sperm injection (“icsi”).
- ovulation induction.
- storage of oocytes, spermatozoa embryos and tissues.
- surgery, including microsurgical sperm aspiration.
- medical and laboratory services that reduce excess creation of embryos through cryopreservation and thawing of ovules in accordance with an individual’s religious or ethical beliefs.
- requires that infertility treatment or procedures be performed in facilities that comply with the American Society for Reproductive Medicine and the Society for Endocrinology and Infertility.
- A policy may not impose restrictions on the coverage of fertility drugs that are different from those imposed on any other prescription drug, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for required fertility care services, which are different from those imposed on benefits for non-inferential services usefulness.
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- Experimental fertility care services, monetary payments to gestational carriers or surrogates, or reversal of voluntary sterilization performed after the covered person has successfully procreated with the covered person’s partner are not covered.
- not covered require religious organizations to provide coverage.
- employers who insure themselves or have fewer than 50 employees are exempt from the law’s requirements.