Health Insurance FAQs - What You Need to Know

Insurance coverage is a crucial part of any medical endeavor; assisted reproduction and surrogacy are no exception. One of the most important aspects of this process can also be one of the most overwhelming; we’re breaking down the most common concerns about infertility, surrogacy, and newborn insurance.

Do any health insurance plans cover infertility?

Sometimes. More insurance plans cover infertility than ever before, but it will likely depend on your location. Currently, 15 states, including Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia mandate or offer fertility coverage to some degree.

How to know if your insurance covers infertility treatments? Simply contact your provider for details. If the answer is yes, dig a little deeper. There are several different categories insurance policies may fall under, including:

•   Insurance Coverage for Infertility Diagnosis

• Insurance Coverage for Infertility Diagnosis and Limited Treatment
• Full Infertility Insurance Coverage
• Medication Coverage (which may or may not include fertility drugs)

What do you need to know when using health care to cover infertility treatments? Confirm with your provider what aspects of treatment are covered and to what extent, such as:

•   Fertility testing

• Fertility medication
• Monitoring
• IVF procedure
• Additional procedures, such as intracytoplasmic sperm injection (ICSI) or preimplantation genetic testing (PGT)

Another common question: does Medicaid cover fertility treatments? The answer is no; fertility services cannot be covered by Medicaid. Some people have success with supplemental insurance. What is a supplemental infertility insurance plan? It may pay for treatment if the underlying cause is a covered medical condition. That means it is not pre-existing and that treatment is medically necessary. While supplemental insurance may not cover the fertility treatment itself (or there may be a 12-month exclusion for pre-existing conditions) it covers the outcome of the treatment and can be helpful for needs during the pregnancy and birth.

Do surrogate mothers need to have health insurance coverage?

Yes. In fact, surrogate health insurance is one of the most crucial pieces in the entire process. It protects both the surrogate and the pregnancy, and it is a requirement of ConceiveAbilities. A surrogate’s existing plan is reviewed as a part of our extensive screening process to give a baseline of what is covered and to confirm if there is a surrogacy exclusion clause. However, relying on her insurance is a risky choice because her coverage could change at any point during the surrogacy engagement. The last thing you want is for a doctor or hospital to change mid-pregnancy, or worse, for her to suddenly be without any coverage. And from a financial standpoint, it may not be the most cost-effective choice.

Some people choose to purchase an individual plan from the market, but given the uncertainty of surrogacy coverage, we do not recommend this option. Her current coverage may also include a dual coverage exclusion, making her ineligible anyway.

The safest alternative to the individual market is a Universal Life plan through Lloyd’s of London. Comprehensive Surrogacy Insurance allows the surrogate to see any doctor agreed upon by all parties, and deliver at any hospital – it’s ideal to deliver at a facility with a NICU, and a small local hospital may not have one.

So what are the legal aspects of surrogate mother health insurance? The details vary from match to match, but your legal documents will reflect the specifics. It will also establish parenthood and responsibility for the child, which leads us to the last piece of insurance you’ll want to secure.

Health insurance for newborns

Are newborns covered by health insurance? Yes, as long as they are placed under the parents’ plan. Newborn health insurance laws through the Affordable Care Act (ACA) add important protections, particularly the Newborns’ Act. How long do you have to get insurance for a newborn? According to the US Department of Labor, you should enroll your baby within 30 days of birth. Coverage will then be effective as of the baby’s birth date and cannot be subject to a preexisting condition clause.

In a process that sometimes feels out of your control, it’s important to remember that you do have choices. Our goal is to present all of the options so that you can choose what works best for your family. To learn more about surrogate insurance, contact our team today.