Posts Tagged ‘insurance’

LOS ANGELES—Blue Cross of California complied with state law when it offered only $2,000 in annual coverage for fertility treatments and was not obligated to cover the entire cost, a California appellate court ruled. At issue in Wednesday’s ruling by the state appellate court in Los Angeles was a renewal package offered by Thousand Oaks, Calif.-based Blue Cross of California to Santa Barbara, Calif.-based Westmont College. The offer included paying a maximum of $2,000 a year for half of the cost of treating a group member for infertility, which complied with a state mandate that obligates insurers to offer infertility coverage, according to the ruling in Deborah Dunn Yeager vs. Blue Cross of California.

Westmont refused to buy the coverage, in part because of its high cost. Ms. Yeager, a Westmont employee, was unable to become pregnant without medical assistance and could afford only limited infertility treatment, which proved ineffective, according to the decision.

She sued Blue Cross in 2006, alleging unfair competition and false advertising. Ms. Yeager sought recovery for her out-of-pocket expenses for the infertility treatment above Blue Cross’s $2,000 annual limit and “for her pain and suffering from losing her chance to bear a child.”

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Many couples pay out-of-pocket for infertility diagnosis and treatment. This is because many employers still do not offer infertility benefits. Pending the type of fertility treatment rendered, costs may vary from a few hundred dollars to $15,000.00 or more.

According to Resolve, the national infertility association, only 15 states have laws requiring insurance coverage for infertility treatment. These laws are known as mandates. There are two types of mandates:

  • Mandates to Offer: Mandates to offer require insurance companies to offer policies that cover infertility diagnosis and treatments. Employers must be made aware of these policies but are not required to include them in their employee benefits package.

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