The recently passed Health Care Reform Act nearly created a windfall for couples trying to conceive who do not have infertility health insurance coverage. Beginning in 90 days after passage of the act, a national high risk pool will be created. Pre-existing conditions (such as infertility perhaps?), must be covered, and the premiums must fall in the same range as plans for people with varying risk levels. Could this mean affordable infertility health insurance for couples whose employers do not currently offer such a plan? It comes close to doing just that. And perhaps a select group of couples will emerge as winners from this new legislation. The majority must be more creative.
The Health Care Reform Acts calls for the creation of a national high risk pool that is meant to provide a temporary solution until the state run exchanges are up and running. People with pre-existing conditions will be eligible to enroll. Some issues are clear, while others are not. One fact is clear: many couples diagnosed with infertility issues have pre-existing conditions, and their current health insurance plan provides no coverage.
What is less clear is whether the high risk pool with cover infertility treatments. States will be given some leeway in the creation and operation of the plan. Fifteen states currently have laws mandating some form of insurance coverage for couples coping with infertility. Even with these laws in place, there are many loopholes, leaving large portions of their infertile population without any coverage. It is possible that some of those states will include infertility coverage for people in this pool. If you live in one of those states, and your employer's plan does not offer coverage, stay tuned.
Should the high risk pools cover infertility, it should be quite a bargain for couples trying to conceive. The law requires that the premiums for these plans be no more than would be charged for a standard population with varying risks. In other words, you may find a plan with infertility coverage that is actually affordable - because the insurers are being forced to sell you a policy at a loss. Without this mandate, insurers would price such policies so that premium exceeded benefits paid, making it terribly expensive to get coverage.
Should couples trying to conceive drop their employer sponsored health plan that offers no infertility coverage, and move to a plan from the high risk pool? This choice makes sense for only a very small portion of the population. First, you would want to verify that the pool covered infertility. That is likely to be the case only in the states with a fertility mandate, and at the time this article was written it is just too early to tell. Second, the law will enroll only applicants who have been uninsured for six consecutive months. You would be taking huge risks to your health and finances to go without insurance that long just to get your IVF covered.
The one segment that may benefit: couples trying to conceive, without any health insurance coverage today. If this describes your situation, check into your state infertility mandates, and research what is happening in your state's high risk insurance pool.
For the rest of you, consider supplemental health insurance. Your benefit for normal pregnancy may greatly exceed your premium paid. Use the excess to offset your infertility treatment costs.
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