For the first time, all Connecticut health insurance companies will be required to cover infertility treatment for people age 40 and older.
The state’s Insurance Department said that failure to provide the coverage constitutes age discrimination in violation of the federal Affordable Care Act (ACA). The new requirement takes effect Jan. 1.
“Limits to coverage that are discriminatory run counter to the clear intent of the Affordable Care Act and we must ensure that our state laws and guidelines are compliant,” said state Insurance Commissioner Katharine L. Wade.
The change was prompted by a study by the National Women’s Law Center that cited illegal age discrimination in infertility coverage in Connecticut. C-HIT reported on the study in June. The state had been operating under a state law, which preceded the ACA, that capped infertility coverage at age 40. The ACA supersedes state law, said Karen Davenport, the law center’s director of health policy.
The new mandate requires the coverage when medically necessary and includes women and men. More infertility procedures are available for women, Davenport said.
Companies will be permitted to impose a co-pay up to 50 percent, a deductible, or co-insurance if they are consistent with terms and conditions of other benefits in a policy, but they can’t vary by age, said Donna M. Tommelleo, insurance department spokesperson.
The ACA prohibits such cost sharing for a variety of women’s preventive health services, such as birth control, mammograms, and pap smears, but infertility isn’t one of them, Davenport said.
Meanwhile, she said the law center still finds fault with coverage for breast-feeding services in Connecticut. She said there are ambiguities in federal rules governing the coverage and the law center is lobbying for changes on the federal level to clear them up. Until and if that happens, “that is something that we end up disagreeing on with the state,” she said.
The state requires coverage for breast-feeding counseling and education for an undefined postpartum period, while the law center maintains that it should be covered for the entire time a woman is breast-feeding.
The law center is also pressing the U.S. Department of Health and Human Services to immediately issue regulations to implement the ACA’s “broad prohibition against discrimination in health care,” said Marcia Greenberger, co-president.
“We still have more work to do,” Greenberger said, calling the discrimination prohibition “a critical provision” of the law.
The state Insurance Department consulted with the law center and insurers before changing the infertility mandate, Wade said.
Greenberger called Connecticut’s action an “important step forward towards eradicating discrimination in our health care system.” She added, “Connecticut has made a major part of the law’s protections work for women and their families.”
Susan Lloyd Yolen, vice president of public policy and planning for Planned Parenthood of Southern New England, said, “There are an increasing number of women who choose parenthood later in their reproductive lives, only to experience infertility.” She said it helps fulfill the promise of the ACA to provide women “with the tools to plan their families as they see fit.”