Guide to Navigating Infertility Treatment Coverage in Illinois – 2022

On January 1, 2022, there was a change in the definition of infertility in the Illinois insurance code, under the Public Act 102-0170.

What is the Public Act 102-1070?

  • Public Act 102-0170 updates the definition of infertility in Illinois to be more inclusive of LGBTQ+ people and single parents seeking to start families.
  • Previously in Illinois, infertility was defined as “the inability to conceive after one year of unprotected sexual intercourse.” This definition of infertility was heteronormative and denied coverage to many LGBTQ+ people wanting to start families.
  • Public Act 102-0170 updates the definition of infertility in the Illinois Insurance Code to a disease, condition, or status characterized by:
    • A failure to establish a pregnancy or to carry a pregnancy to live birth after 12 months of regular, unprotected sexual intercourse if the woman is 35 years of age or younger, or after six months if the woman is over 35 years of age;
    • A person’s inability to reproduce either as a single individual or with a partner without medical intervention; or
    • A licensed physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.
  • Expanding the definition of infertility ensures that LGBTQ+ people and single people are not discriminated against in accessing infertility treatment insurance coverage.

Does your insurance provide coverage for infertility treatment?

  • Insurance plans ARE required to provide coverage for the diagnosis and treatment of infertility if the plans are both:
    • Illinois-based
    • Group insurance plans providing coverage for more than 25 employees that cover for pregnancy related services
  • Insurance plans are NOT required to provide coverage for:
    • Group plans with 25 or fewer employers
    • Individual plans
    • Medicaid

What insurers and HMOs* are likely to provide coverage in 2022?

  • 4 Ever Life Insurance Company
  • Aetna Health Inc.
  • Aetna Health Insurance Company
  • Aetna Life Insurance Company
  • Cigna Health and Life Insurance Company
  • Cigna Healthcare of Illinois, Inc.
  • Golden Rule Insurance Company
  • Health Alliance Medical Plans, Inc.
  • Health Alliance Midwest, Inc.
    Health Care Service Corporation (Blue Cross Blue Shield IL)
  • Humana Health Plan Inc.
  • Humana Insurance Company
  • Medical Associates Health Plan, Inc.
  • MercyCare HMO Inc.
  • Nippon Life Insurance Company of America
  • Quartz Health Benefit Plans Corporation
  • Quartz Health Insurance Corporation
  • Quartz Health Plan Corporation
  • UnitedHealthcare Insurance Company
  • UnitedHealthcare Insurance Company of Illinois
  • UnitedHealthcare Insurance Company of the River Valley
  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare of Illinois, Inc.
  • Wisconsin Physicians Service Insurance Corporation (WPS)

*The above list of insurers and HMOs have filed forms with the Department of Insurance (DOI) in 2019 indicating an intent to sell or renew large or small group plans. All such plans issued to employers with more than 25 employees must comply with the new law. The list is not an exhaustive or guaranteed list of carriers that will be subject to the new law, due to a variety of reasons, including that some plans may not be selling large group insurance in 2022 even if they registered in 2019, the DOI may have missed some insurance plans, or the plans may only be selling small group plans.

What should I ask my insurance provider about coverage of infertility treatment?

  • I am interested in learning more about coverage for infertility treatments in my insurance plan. Specifically, a new law, Public Act 102-0170, went into effect in Illinois on January 1, 2022. This law amends the Illinois Insurance code to update the definition of infertility used to determine coverage and it also ensures coverage parity. Is my plan in compliance with this new law?

What should I do if I think my insurance should cover treatments that they are not covering?

Howard Brown Health offers an Alternative Insemination (AI) program for the lesbian, bisexual, transgender and queer community. Our program provides holistic, affirming care to individuals, couples, and families as they prepare for pregnancy and begin the conception process.

Tags: Advocacy


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