The International Council on Infertility Information Dissemination, Inc

The Pregnancy Discrimination Act: What you need to know

Facts About Pregnancy Discrimination
The Pregnancy Discrimination Act is an amendment to Title VII of the Civil Rights Act of 1964. Discrimination on the basis of pregnancy, childbirth or related medical conditions constitutes unlawful sex discrimination under Title VII. Women affected by pregnancy or related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations.

 

Hiring
An employer cannot refuse to hire a woman because of her pregnancy-related condition as long as she is able to perform the major functions of her job. An employer cannot refuse to hire her because of its prejudices against pregnant workers or the prejudices of co-workers, clients or customers.

 

Pregnancy and Maternity Leave
An employer may not single out pregnancy-related conditions for special procedures to determine an employee's ability to work. However, an employer may use any procedure used to screen other employees' ability to work. For example, if an employer requires its employees to submit a doctor's statement concerning their inability to work before granting leave or paying sick benefits, the employer may require employees affected by pregnancy-related conditions to submit such statements.

 

If an employee is temporarily unable to perform her job due to pregnancy, the employer must treat her the same as any other temporarily disabled employee; for example, by providing modified tasks, alternative assignments, disability leave or leave without pay.

 

Pregnant employees must be permitted to work as long as they are able to perform their jobs. If an employee has been absent from work as a result of a pregnancy related condition and recovers, her employer may not require her to remain on leave until the baby's birth. An employer may not have a rule which prohibits an employee from returning to work for a predetermined length of time after childbirth.

 

Employers must hold open a job for a pregnancy related absence the same length of time jobs are held open for employees on sick or disability leave.

 

Health Insurance
Any health insurance provided by an employer must cover expenses for pregnancy related conditions on the same basis as costs for other medical conditions. Health insurance for expenses arising from abortion is not required, except where the life of the mother is endangered.

 

Pregnancy related expenses should be reimbursed exactly as those incurred for other medical conditions, whether payment is on a fixed basis or a percentage of reasonable and customary charge basis.

The amounts payable by the insurance provider can be limited only to the same extent as costs for other conditions. No additional, increased or larger deductible can be imposed.

Employers must provide the same level of health benefits for spouses of male employees as they do for spouses of female employees.

 

Fringe Benefits
Pregnancy-related benefits cannot be limited to married employees. In an all-female workforce or job classification, benefits must be provided for pregnancy-related conditions if benefits are provided for other medical conditions.

 

If an employer provides any benefits to workers on leave, the employer must provide the same benefits for those on leave for pregnancy-related conditions.

Employees with pregnancy-related disabilities must be treated the same as other temporarily disabled employees for accrual and crediting of seniority, vacation calculation, pay increases and temporary disability benefits.

 

 

See also: How To File A Charge of Employment Discrimination

 

Miracles and Memories Pins

Miracles and Memories Pin

Miracles and Memories PinConsider the first and ONLY family-building INCIID Miracles and Memories pin for yourself, your family and friends - or if you are a reproductive endocrinology and infertility clinic or a patients who might want to provide them to your extended family members or to friends. INCIID was the first to come out with a pin covering all aspects of family-building.

Providing these particularly during "parenting" holidays (Christmas, Mother's Day, Father's Day etc.) can be supportive and helpful to those struggling to build their family. For thousands of reproductively challenged couples, the holidays can be a difficult time, as their only wish is to have a family of their own. If you are a doctor caring for patients,  INCIID is asking you to give out “Miracles and Memories” family-building pin to show patients and staff in a small but caring way that you support efforts to build a family. The idea is to build awareness and support for INCIID, a non-profit organization, providing scholarships for couples with infertility diagnoses as well as support and information on family building options. If you are a patient, or the family of a patient struggling with fertility, pregnancy loss or making the decision to adopt - Miracles and Memories Pins can provide added support.

Because INCIID is a non-profit organization, it relies solely on donations and contributions to maintain the success of the “From INCIID the Heart” scholarship program.  The INCIID team has created “Memories and Miracles” pins. INCIID is asking  couples, doctors, family members to donate just $25 to increase infertility awareness while at the same time providing a tax deductible donation to increase awareness and in support of creating a family.

The pins are packaged in a small clear plastic baggy attached to a white card that explains representation of each color on the pin and that pins support INCIID’s work and the IVF Scholarship.

The MAM (Miracles & Memories) Family-Building Pin :

Download the Bulk order form (for bulk orders of 100 or more pins) including a photo of the Miracles and Memories (MAM) pins

 

 

Adoption Advocacy - National Zoo Exploits Children with Adopt-a Confusion

Dear Adoption Community

I received the following letter from the National Zoo's Deputy Director in response to the letter I sent several weeks ago. As you can see from their response, it is clear they don't "get it". I sent Mr. Schroeder a copy of the Adopt-a Confusion fact sheet as well as a letter encouraging them to stop using the adopt-a theme which I as way as many experts and researchers believe exploits children.

Please write to them and tell them adopt-a confusion is not OK and feel free to pass this on to anyone who has an interest in educating the public about respectful adoption language and the problematic programs using adopt-a confusion to raise money for their respective causes!

Thanks

Nancy

Nancy P. Hemenway
INCIID Executive Director
(703) 379-9178 (Office)
(703) 379-1593 (FAX)
http://inciid.org
INCIIDinfo@inciid.org
----------------------

Dear Ms. Hemenway:

Thank you for sharing your thoughts about our Adopt a Species program: This has been an exceptionally busy period for FONZ and I apologize for the delayed response.

Our intention in using the phrase "adopt a species" is deliberately metaphoric and symbolic, and in no way trivializes the process of building a human family through adoption. We hope to inspire people to make a lifetime commitment to cro;ing about and working toward a secure future for wild animals and the habitats they need to survive, analogous, although certainly not identical, to, the comtp.itment adoptive parents make to their children. We also hope that the financial contribution that people make to adopt a wild animal species is just one of many ways that they help to ensure the survival of wildlife, just as financial support is just one of the many ways that parents ensure the welfare of their children, adopted or not.

After receiving your email, I asked the advise of a thoughtful 21-year-old who is an adopted child. The following is from her response:
I like the phrase "adopt a species." Although you're not taking the animal home, expressing your human love for it, and nurturing it through years ofJife until you send it off to college-you can, and I've witnessed people, fall in love with an animal (in a broader sense) and devote time and money to its cause-which, in my opinion, is just as worthy of the term "adoption." As a child growing up in the environment-conscious nineties I often heard the term adopt in phrases like "adopt a whale" "adopt a highway" and "adopt an endangered species" and never once did it bother me. In fact I thoughtit was really cute and really great-,-and really liked the idea of "adopting" even a highway. I loved seeing the "adopt a highway" or "adopt a road" signs and reading which school children were taking care of it. Kids are way tougher and smarter than parents believe. They know the difference. If anything, I know similar phrases ~arked (in me and other kids dreams of actually adopting a panda and having the panda live with us for a lifetime to become a true family member-what a fantasy!

Indeed, this is the experience of just one child, but I suspect that hers is representative of that of many children. Undoubtedly, as your examples indicate, some other children may be puzzled about how their adoption is like or unlike these other "adoptions." However, we have structured our programs to avoid the suggestion that someone is literally adopting a particular individual animal or that one animal is worth more than other. Our program encourages people to adopt an entire species, emphasizing the metaphor, and attaches identical value to each of the species that people can adopt. We do not substitute a new species for adoption each year-people can and do symbolize their commitment to wildlife conservation by adopting the same species for many years. .

We agree that some adopt programs are silly, and that the "adQption" of a pothole or a light bulb in no way compares to adopting a child; in our view, neither of these compares either to adopting a species, in the sense of making a commitment to caring for the future of the animals with whom we share the planet.

Sincerely,
James M. Schroeder
Deputy Executive Director Friends of the National Zoo Washington, D.C. 20008

Friends of the National Zoo. Smithsonian's National Zoological Park, 3001 Connecticut Avenue, NW, Washington, D.C. 20008, 202 6734961. www.fonz.org

Below Please find below the National Zoo  CONTACT INFORMATION 
-------------------------------

Please politely inform the zoo staff and board members that The National Zoo has suffered so much embarrassing controversy lately, that exploitive and controversial adopt-a programs might expose the zoo to more negative attention from the adoptive professional and parenting community.
If you have time --- By far, a neatly hand written or typed letter gets much more attention than sending an email. Sending an email as a follow-up is effective, but for the greatest impact make sure to send that postal letter. Since it takes a little bit more work than just sending an email it shows that you really care about the topic if you are willing to put in the extra effort. 

Zoo Staff

Smithsonian National Zoological Park
3001 Connecticut Ave., NW
Washington, DC 20008 

Lucy Spelman, spelmanl@nzp.si.edu, Director of the Smithsonian National Zoo
Clinton A. Fields, fieldsc@nzp.si.edu, Executive Director, FONZ
Jim Schroeder, schroederj@nzp.si.edu, Deputy Executive Director, FONZ

Friends of the National Zoo (FONZ) Board of Directors 

To contact any FONZ Board Member, send an email to:board@fonz.org 

Or send postal mail to:

Friends of the National Zoo
3001 Connecticut Ave., NW
Washington, DC 20008 

Lloyd W. Howell, Jr., President of the Board of Directors 

Mark R. Handwerger, First Vice President 

Jeffrey Lande, Second Vice President 

Grace Y. Toh, Treasurer 

Nicole M. Chestang, Secretary 

Other Directors: Thomas B. Arundel, Marcie Bane, Patricia A. Bradley, Jeanne Beekhuis, Christopher Capuano, Robert V. Davis, Sheila M. Ford, Michele V. Hagans, James F. Hinchman, Richard C. Hotvedt, Bernard K. Jarvis, Alberta A. "Missy" Kelly, Robyn S. Kravit, Gloria Kreisman, Harald R. Leuba, Suzanne Mink, Sue Ruff, Edward A. Sands, Eric Douglas Weiss, and John J. Ziolkowski 

Smithsonian Institute Contact Information

Smithsonian Institute
PO Box 37012 
SI Building, Room 153, MRC 010 
Washington, D.C. 20013-7012 
info@si.edu 

Smithsonian National Zoo Board of Regents 

Regents ex officio 
Chancellor William H. Rehnquist, Chief Justice of the United States, c/o Smithsonian Institution MRC-016, P.O. Box 37012, Washington, DC 20013-7012, ph 202.479.3400 

Vice President Richard B. Cheney,vice.president@whitehouse.gov, postal addr as above or The White House 1600 Pennsylvania Ave., Washington, DC 20500, ph 202.456.1414 

Congressional Regents 
Senator Thad Cochran, senator@cochran.senate.gov,ann_copland@cochran.senate.gov, postal addr c/o Smithsonian Institute (SI) or 326 Russell Senate Office Building, Washington, DC 20510-2402, fx 202.224.9450, ph 202.224.5054 Senator 

Bill Frist, emily_reynolds@frist.senate.gov, postal addr c/o SI or 416 Russell Senate Office Building Washington, DC 20510, fx 202.228.1264, ph 202.224.3344 

Senator Patrick J. Leahy, senator_leahy@leahy.senate.gov , postal addr c/o SI or 433 Russell Senate Office Building, Washington, DC 20510, fx 202.224.3479, ph 202.224.4242 

Honorable Sam Johnson, michael.hanson@mail.house.gov , postal addr c/o SI or 1211 Longworth House Office Building, Washington, D.C. 20515, fx 202.225.1485, ph 202.225.4201 

Honorable Robert T. Matsui, jim.bonham@mail.house.gov, postal addr c/o SI or 2310 Rayburn House Office Building, Washington, DC 20515, fx 202.225.0566, ph 202.225.7163 

Honorable Ralph Regula, repregula@workinohio.org, postal addr c/o SI or 2306 Rayburn House Office Building, Washington, D.C. 20515, fx 202.225.3059, ph 202.225.3876 

Citizen Regents 
Honorable Barber B. Conable Jr., bconable@worldbank.org, P.O. Box 218, Alexander, NY 14005, fx 202.477.6391, ph 716.591.1233 

Dr. Anne d'Harnoncourt, pr@philmuseum.org, Philadelphia Museum of Art, Benjamin Franklin Parkway and 26th Street, Philadelphia, PA 19130 (or P.O.Box 7646, Philadelphia PA 19101-7646), fx 215.232.4338, ph 215.763.8100 or 215.684.7600 

Dr. Hanna H. Gray, h-gray@uchicago.edu, University of Chicago, Department of History, 1126 East 59th St., SS Box 109, Chicago IL 60637-1539, fx 773.702.4600, ph 773.702.7799 

Dr. Manuel Ibanez, manuel.ibanez@tamuk.edu, Texas A&M University-Kingsville, Dept. of Biology, P.O. Box 158, Station 1, Kingsville, Texas 78363 (or 7737 Starnberg Lake Dr., Corpus Christi TX 78413-5288), ph 361.854.5818 

Dr. Walter E. Massey, wmassey@morehouse.edu, Morehouse College, 830 Westview Drive SW, Atlanta, GA 30314, fx 404.659.6536, ph 404.681.2800 

Mr. Roger W. Sant, mcalmes@summitfdn.org, The Summit Foundation, 2099 Pennsylvania Ave. NW 10th fl, Washington, DC 20006, fx 202.912.2901, ph 202.912.2900 

Mr. Alan G. Spoon, aspoon@polarisventures.com, Polaris Venture Partners, 1000 Winter Street, Suite 3350, Waltham, MA 02451-1215, fx 781.290.0880, ph 781.290.0770 (or 7300 Loch Edin Ct, Potomac MD 20854-4835, ph 301.365.4650) 

Ms. Patty Stonesifer, media@gatesfoundation.org, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA 98102, fx 206.709.3184, ph 206.709.3100 

Mr. Wesley S. Williams Jr., WWilliams@cov.com orwwilliams@lockhart.com, Covington & Burling, 1201 Pennsylvania Avenue NW, Washington, DC 20004-2401, fx 202.778.5628, ph 202.662.5628 (or 7706 Georgia Ave. NW, Washington DC 20090, 202.726.3631) 

Also -- for alerts please sign up for our Adoption Hit List.

Insurance Advocacy Forum

In the United States, one of the richest and most technically advanced nations on earth, millions of couples remain involuntarily childless. A conservative estimate places the number of U.S. couples that grapple with infertility annually at 5,000,000, yet less than 20% of those couples will undergo some form of definitive treatment. The high cost of infertility treatment, especially the advanced Assisted Reproductive Technologies (ART) such as In Vitro Fertilization (IVF), has resulted in reluctance on the part of most insurance companies to provide benefits for infertility and therefore, has rendered such medical intervention financially inaccessible to the general infertile population. Although a few states have enacted legislation requiring health insurance providers to offer or provide infertility benefits, such coverage is often limited, or absent altogether due to regulatory loopholes. The majority of employer groups as well as health insurance providers continue to avoid voluntarily including infertility benefits. They recognize that such benefits would spawn an increase in the demand for these specialized services. This fuels their fear of the spiraling costs that might be brought about by a disproportionate increase in the demand for expensive ART, and the costly neonatal services required to deal with the potential influx of premature babies resulting from IVF-related multiple births.

Visit the insurance Advocacy forum on INCIID

 

Ways to Support INCIID

Ways you can contribute to INCIID

 

• Donate online (http://inciid.org/donate)  with an electronic Check , Through Paypal or by a Visa, MasterCard, American Express or Discover Credit Cards
• Fax your contribution to (703) 379-1593 
• Call in your contribution (703) 379-9178

When you donate, be sure to check with your employer benefits department to see if your employer has a Matching Program. This means your tax deductible donation to INCIID is matched dollar to dollar by your employer and sent to INCIID.

 

 

Other Ways to Help Supplement INCIID

 

Food Lion Shop & Share Program
If you shop for groceries at Food Lion, you can register your MVP card in the Shop and Share Program at www.foodlion.com or by calling 1-704-633-8250 extension 3810. 
Choose INCIID as your charity of choice, and a percentage of all Food Lion purchases you make will come back to INCIID, as long as you use you registered MVP card each time you shop.

 

Give through the United Way

INCIID gets many United Way contributions throughout the year through a write in process. Check with your employer to see if your company will allow you to write in a designee for your contribution, you can write us in as follows:

INCIID, Inc
(Full Name is --- The InterNational Council on Infertility Information Dissemination, Inc.) 
PO Box 6836 Arlington, Virginia 22206

 

Amazon.com
Shop at Amazon. http://www.inciid.org/article.php?cat=treatment&id=385 
Click on any of the Amazon links throughout the INCIID Website as well as using the Amazon search engine.

 

Shop the INCIID Store Front

Purchase apparel and merchandise that helps support the INCIID mission.
Recently INCIID Volunteers put together a fund-raiser cookbook with some great recipes. 
Please visit our shop for more details.

 

American Express Membership Rewards
If you are an American Express cardholder and you would like to donate Membership Rewards points to INCIID visit http://www.americanexpress.com/give/ , and search for InterNational Council on Infertility Information Dissemination, Inc., In Arlington, Virginia. 
Follow the directions to donate. You can use this form to donate money or to contribute your membership rewards points. 
Points can help us with travel expenses etc.
INCIID is a 501 (c) 3 incorporated in the Commonwealth of Virginia

 

Insurance Coverage for Infertility Treatment

Insurance Coverage for Infertility TreatmentStudy your plan to reverse claim denials
By Pamela Prager

 

Couples who face infertility not only face the emotional pain associated with not being able to have a child, but may also face obstacles put in front of them by their health insurance and employers. The following guidelines are designed to assist couples to overcome some of these obstacles on their own.
However, every situation is different under the law, and an attorney should be contacted for assistance with specific legal problems. Should it be necessary to seek legal advice, the references listed at the end of this article will be of assistance in evaluating your case.

 

Insurance

Many insurance carriers do not provide health insurance coverage for infertility, or provide only very limited insurance coverage. If your claims for infertility treatment have been denied, take the following steps:

State Mandates
Determine whether or not you live in a state that has mandates for infertility insurance coverage. There are a handful of states that mandate insurance coverage for infertility to some extent or under certain conditions.

Your Insurance Contract
Read your insurance contract. Most people obtain their health insurance through their employer, who provides a "summary" of the health insurance plan. Although this is helpful to some extent, it is the actual contract which controls your health insurance issues. If you do not have a copy of your contract, ask your employer for a copy. Under the Employees Retirement Income Security Act (ERISA) a federal law which regulates pension and insurance benefits provided to employers to employees, your employer is required to give you a copy.
Insurance contracts are construed against the insurance carrier. Generally speaking, if the contract does not have an exclusion for infertility, the insurance company must pay benefits.
Read your contract to determine if there is a specific exclusion for infertility. If there is not an exclusion, you should have coverage. If there is an exclusion, carefully read what it excludes. Does it exclude treatments only, or does it also exclude diagnosis?
As an example, I recently represented a woman who had a laparoscopy with an incidental chromotubation because of complaints of pelvic pain. The insurance carrier denied the claim stating it was for the treatment of infertility. By taking the claim through the grievance process, eventually the insurance carrier made a determination to pay the benefits. We were able to establish that the laparoscopy was not done for infertility, but for pelvic pain. More importantly, the contract only excluded "treatment" of infertility. Since the procedure was diagnostic, the insurance carrier determined that it was required to make the payment. Thus, it is very important that you determine what is excluded and ultimately the reason the insurance carrier is denying the claim.
Your insurance carrier can only deny benefits for what it has excluded.
 

Appealing Denials of Claim

If you have read your contract and believe you should have coverage (and your insurance carrier has denied a claim or stated you do not have coverage when preauthorization is requested), write your insurance carrier and ask for identification of the specific reasons for the denial and under what provision of the contract your claim is being denied.
In the past, insurance carriers that do not have exclusions have denied claims for one of the following three reasons:

  1. Infertility is not an illness;
  2. Treatment of infertility is not medically necessary;
  3. Treatment of infertility is experimental.

 

These are invalid reasons to deny your claim. Infertility is an illness (2). Medically necessary is usually defined by insurance policies as medically required and medically appropriate for diagnosis and treatment of an illness or injury under professionally recognized standards of health care. Treatments such as GIFT, IVF, ZIFT/PROST have NOT been on the American Medical Association's experimental list since the late 1980s.

If the insurance carrier gives another reason, you should review your policy carefully and determine if the reason they give is consistent with the insurance contract.

Once the insurance carrier has identified to you the reasons for the denial of the claim, you can then present evidence to it that its reasoning is incorrect. This may include a letter from your doctor explaining the reasons for a particular procedure. You should also write a letter to the insurance carrier explaining why you believe its denial was inappropriate.

You should attempt to make all contacts with the insurance carrier through written communication. If you should need to contact them by telephone, record the call if possible. If not, take extensive notes, which should include the date and time called, who you spoke with and what was said.

 

Violation of Discrimination Laws

If it appears that the exclusion is valid under the insurance contract, it may nevertheless be invalid under Federal Discrimination Laws. These laws are currently being tested in some Courts throughout the country as to how they should be applied to persons with infertility. The law is not settled and the results may be different between jurisdictions. 
You must keep in mind that to recover under these laws you will most likely have to take legal action against your employer. This prospect is very frightening for most people in that they are afraid their employer will retaliate by terminating their employment. Although this is also illegal, there is little an attorney can do to prevent this from happening. The only remedy for such retaliation is to bring an additional claim for retaliation and ask for reinstatement or money damages. 
Although it may be possible to bring an action directly against the insurance carrier, the less riskier claim as far as likelihood of success is against your employer. In order to be covered under the discrimination laws, your insurance must be through your employer or your spouse's, and the employer must have 15 or more employees. 
The Americans With Disabilities Act (ADA), which was passed in 1991, provides that it is unlawful to discriminate against persons with disabilities. The definition of a disability includes any physiological disorder or condition of the reproductive system. The disability must affect a major life activity. The legislative history, and case law, support the proposition that procreation or reproduction is a major life activity. Therefore, it is unlawful under the ADA to treat persons with disabilities differently than other employees in terms or conditions of employment, including fringe benefits. 
Although the ADA has a specific section which protects some insurance plans, the Equal Employment Opportunity Commission (EEOC) has issued guidelines in interpreting this provision that are vary favorable to persons whose infertility insurance excludes infertility. The Guidelines provide that in order to have the protections of the insurance provision, the insurer must basically establish that it is financially impossible to include the coverage. Insurance carriers cannot establish this. Studies on the cost of infertility coverage have clearly shown that the costs are minimal, approximately $1 to $1.50 per month per family policy. 
Title VII of the Civil Rights Act provides that sex discrimination includes discrimination based on pregnancy, childbirth or related medical conditions. It has been held that infertility is a medical condition related to pregnancy. Therefore, an employer cannot treat you any differently than its other employees as far as providing insurance benefits, time off from work, etc.

 

Time Off From Work

The provisions of the ADA and the Pregnancy Discrimination Act would also protect you when you need to take time off work for treatments. Your employer must treat you the same as all other employees when making decisions as to utilization of sick leave, vacation leave, or other provisions for time off from work for medical reasons. 
In addition, under the Family Medical Leave Act, any employer that has 50 or more employees must give you time off from work for medical treatment. There are certain limitations on this requirement, and it has not been conclusively determined whether or not infertility would be a covered condition. However, there is a good probability that it would be included under the clear language of the statute. If your employer is reluctant to give you time off from work to obtain your treatments, then you should specifically tell your employer (assuming that there are more than 50 employees) that you a requesting time off pursuant to the Family Medical Leave Act, and ask your supervisor what you need to do to obtain such leave. Generally, you will be given a form to complete which will require a statement from your doctor that it is necessary for you to miss work. 
This is only a summary of some of the legal protections you may have under various federal laws. You may also have some protection under your state law. If you have any concerns, it is highly recommended that you contact an attorney in your own state. Most attorneys will provide a free initial consultation. You should try to locate an attorney that specializes in the area of employment and/or insurance law. 

Krauel vs. Iowa Methodist Medical Center:
Infertility coverage takes "beating" in ruling

On October 7, 1995, U.S. District Judge Ronald E. Longstaff ruled in favor of the employer in an Iowa case centering around infertility coverage under the Americans with Disabilities Act (ADA). Despite a string of successful settlements by the EEOC involving disability-based distinctions in health insurance, the judge ruled that discrimination in a health insurance plan does not necessarily violate the law. Peggy Mastrioanni, chief of EEOC's ADA Policy Division is quoted in the Disability Compliance Bulletin as saying, "We disagree with the ... analysis used in this case." The ruling directly contradicts EEOC guidelines, which state that if a disability-based distinction is used as a "subterfuge" to evade the act, the plan is discriminatory and therefore illegal under the ADA. Mary Jo Krauel, the plaintiff in this case, is a 41-year-old respiratory therapist who exhausted all of her financial resources pursuing this law suit. Because waiting until the case is appealed to a higher court may mean she is too old to continue treatment, a trust fund has been established in her name to cover expenses of an in vitro fertilization attempt. If you are interested in contributing, contact Pam Prager Day: (515) 288-0145 or Evening: (515)-

On June 25, 1998 the United States Supreme Court issued a ruling that reproduction is a major life activity under the ADA. This ruling effectively overrules the Kraul v. Iowa Methodist Medical Center opinion in the Eighth Circuit. Although this case was decided in the HIV context, it has strong implications for persons with infertility. Infertility meets the requirements of the ADA - i.e. a disease of the reproductive system that affects the major life activity of reproduction. Insurance policies that exclude infertility treatments are very likely to be in violation of the ADA. In addition, employers who discriminate against infertile couples by denying them time off for treatments, etc. are also violating the ADA.

 

Legal Resources

  • Americans With Disabilities Act, 42 U.S.C. S 12101 et seq. Title VII of the Civil Rights Act, 42 U.S.C. S 2000e et seq.
  • Pregnancy Discrimination Act, 42 U.S.C. 2000e(k)
  • Doe v. Kohn Nast & Graf, P.C., 862 F. Supp. 1310, 1319, (E.D. Pa. 1994)
  • Pacourek v. Inland Steel Co., 858 F. Supp. 1393 (N.D. Ill. 1994
  • McWright v. Alexander, 982 F.2d 222, 226-27 (7th Cir. 1994)

 

(1) These states are from research done by this writer in 1989. These states may have amended their statutes since that time, or additional states may now mandate insurance. See Prager,Infertility and the Unrecognized Illness in the Health Insurance Industry, 39 Drake L. Rev. 617 (1989). 

(2) See Witcraft v. Sundstrand Health & Disability Group Benefit Plan, 420 N.W.2d 785 (Iowa 1988); Egert v. Connecticut Gen. Life Ins. Co., 900 F.2d 1032 (7th Cir. 1990). 

 

Pamela Prager is an attorney with the Des Moines, Iowa law firm of Finley, Alt, Smith, Scharnberg, May & Craig, P.C. 

 

The impact of Bragdon v. Abbot on persons affected by infertility by Pamela J Walker

Americans with Disabilities Act

 

In order to have an understanding of the impact of Bragdon v. Abbott on persons affected with infertility, it is first necessary to give a brief overview of the Americans with Disabilities Act (ADA).

 

The ADA was enacted in 1991. Title I of the ADA protects all persons with disabilities and prohibits an employer from discriminating against them in any terms or conditions of employment. Fringe benefits or health insurance plans are a term or condition of employment. Title III of the ADA prohibits any place of public accommodation from discriminating based on disability in its goods, services, facilities, privileges, advantages or accommodations. An insurance carrier is a public accommodation.

 

Most persons with insurance coverage obtain their coverage through their employment. The employer either pays an insurance company the policy premium (premium-paid policy) or is self-funded and retains an insurance company to administer the plan (ERISA). ERISA is a federal law that regulates self-funded pension and insurance plans. An ERISA plan will pre-empt any state laws regulating insurance, but not federal laws. The ADA is a federal law. The type of insurance coverage you have is important to know so that you know who is violating the law. Under a premium-paid policy both your employer and the insurance company are violating the law. Title I prohibits your employer from contracting with any other person, company, etc. that discriminates. The insurance company would be violating Title III. If it is an ERISA plan, it is a little more difficult to claim a Title III violation against the insurance company because the employer generally sets up the terms of the plan (although it is the insurance company that advises them what to do). This information is provided so that if you should decide to bring a claim under the ADA, you understand that if you have an ERISA plan, you will have to sue your employer for a good chance of recovery. You may also sue the administrator of the plan, but the law is unsettled on this issue.

 

The ADA defines a disability as a "physical or mental impairment that substantially limits one or more of the major life activities of such individual." Thus, to be protected under the ADA, a person must establish he or she has (1) a physical or mental impairment that (2) affects a major life activity.

 

A physical or mental impairment has been defined in the Code of Federal Regulations to mean:

Any physiological disorder, or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: Neurological, muscoskelital, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genital-urinary, hemic and lymphatic, skin, and endocrine; or … 
The Code of Federal Regulations also defines major life activities to include walking, seeing, breathing, caring for oneself, etc. Reproduction is not included in the list of major life activities in the Regulations. However, the Regulations do state the list is not exclusive but is given by way of example. Thus, there are major life activities that are not listed.

 

Since the enactment of the ADA there have been many cases where persons with infertility or HIV have sought protection under the ADA. The major issue in these cases was whether or not reproduction is a major life activity under the ADA. There was a split in the decisions. The majority of the Federal District Courts ruled that reproduction was a major life activity. Three of these rulings were appealed to the Federal Court of Appeals, Zatarain v. WDSU-Television (5th Circuit), Krauel v. Iowa Methodist Medical Center (8th Circuit) and Bragdon v. Abbott (1st Circuit). The Fifth and Eighth Circuits ruled reproduction was not a major life activity. The First Circuit ruled that it was. Obviously, the First Circuit ruling was further appealed to the United States Supreme Court.

 

Bragdon v. Abbott

Abbott was infected with the HIV virus. She did not have full blown AIDS. A person infected with HIV, who is asymptomatic, does not necessarily have any major life activities affected, other than reproduction. A person with HIV will forego intercourse and reproduction because he/she does not want to pass the virus to his/her spouse or child. Thus, the only "major life activity" affected is the ability to reproduce.

 

Abbott sought dental care from Bragdon. She informed him that she was infected with HIV. Bragdon refused to treat Abbott in his dental office, but stated he would perform the necessary procedures in a hospital setting, which would have been more costly. Abbott filed a Complaint under Title III of the ADA (public accommodations).

The major issue in the case was whether Abbott was disabled within the meaning of the ADA, i.e. is reproduction a major life activity under the ADA. The United States Supreme Court held that it was. Although Bragdon v. Abbott, was in the HIV context, the ruling also applies to persons with infertility. Thus, persons with infertility are protected under the ADA because they have a physical impairment of the reproductive system that affects their major life activity of reproduction.

 

Thus, under the ADA your employer, and, if relevant, insurance carrier, cannot discriminate against you based on your disability --- infertility. They must treat you the same as other persons. They cannot deny you leave to seek medical treatment if they provide leave for other persons. They cannot fire you for seeking medical treatment or because of your infertility if they would not do the same to others.

 

Safe Harbor
Of course, the big question is, how does this affect my health insurance that excludes or limits infertility treatments? Under the ADA there is an additional provision known as the "safe harbor" provision that affects insurance. Basically what this provision states is that the ADA is not intended to affect how insurance companies do business or how your employer sets up its health insurance coverage unless it is a "subterfuge" under the

ADA.

 

The Courts are still not in agreement as to what this provision of the ADA means. The Eighth Circuit in Krauel, held that to be a "subterfuge" the employer must discriminate in a "non-fringe benefit" aspect of your employment. For example, you have infertility and you are going to cause our insurance costs to increase so we will not hire you or fire you.

 

The Equal Employment Opportunity Commission (the federal agency in charge of enforcing discrimination laws) and other courts have interpreted this language as meaning that the employer must establish that the exclusion or limitation is based on sound actuarial principles. This means they have to establish it is too costly, the premiums will be too high, it will bankrupt the Plan, etc. History has shown that providing coverage for infertility treatments is simply not expensive, i.e., $.34 to $2.00 per family plan per month.

 

 

Summary

In summary, persons with infertility are disabled within the meaning of the ADA. However, the courts are still in a state of flux as to whether or not an employer or insurance carrier may exclude or limit treatments for infertility. The only way of getting the answer is to pursue litigation and attempt to get a case before the United States Supreme Court.

Pamela J. Walker

 

Buzzanca v. Buzzanca: The Ruling and Ramifications

Buzzanca v. Buzzanca: The Ruling and Ramifications
by Andrew W. Vorzimer, Esq.; Milena D. O'Hara, Esq.; Lori D. Shafton, Esq.

 

Jaycee was conceived by an anonymous embryo donation implanted into a gestational surrogate. The surrogate and the Buzzancas had entered into a surrogacy contract in which the surrogate agreed to carry and give birth to a child for them. However, approximately one month before Jaycee was born, John petitioned for dissolution of their marriage. Although Luanne claimed she was the lawful mother, John asserted that he was not responsible in any way towards Jaycee. Despite the fact that the surrogate appeared to disclaim any assertion that she was the legal mother, the trial court stated neither the surrogate nor Luanne was the legal mother. Further, it held that John could not be the legal father. The court's basis for these assertions was a strict, and even incorrect, reading of the Uniform Parentage Act: to be a legal parent, one must either be genetically related to the child or have given birth to the child. Following this reading, the court found that neither Luanne nor John satisfied either of these requirements.

 

California Appeals Court reverses "No Parents" decision in surrogacy case

The renowned "parentless" child resulting from a surrogacy arrangement finally knows who her legal parents are. Yesterday, the California Court of Appeal for the Fourth Appellate District ruled that John Buzzanca and Luanne Buzzanca are the legal father and mother of Jaycee, now three years old. The basis for the court's conclusion was the rule that parental relationships may be established when intended parents initiate and consent to medical procedures, even when there is no genetic relationship between them and the child. Buzzanca v. Buzzanca, Sup. Ct. No. 95D002992 (filed 3/10/98).

 

Uniform Parentage Act criteria is not exclusive

The appellate court's reasoning in reversing the trial court begins with Section 7610 of the Uniform Parentage Act. That section states: "The parent and child relationship may be established as follows: (a) Between a child and the natural mother, it may be established by proof of her having given birth to the child, or under this part; (b) Between a child and the natural father, it may be established under this part; (c) Between a child and an adoptive parent, it may be established by proof of adoption." (Emphasis added).

 

First, the court clarifies that the phrase "under this part" means through genetic consanguinity, as so held in Johnson v. Calvert. Thus, the three listed methods of establishing a relationship are through genetic ties, giving birth or through adoption. In analyzing this section, the court emphasizes the word "may" as meaning that this list of these methods to determine parentage is not exclusive, and it may in fact be determined in other ways. This is evidenced by the fact that under section 7611, a man may establish paternity by being married to the mother when she gives birth, or marrying her thereafter if he either consents to being named the father, or promises in writing to support the child. It is possible that he may not be genetically related to the child, but he may nevertheless establish paternity.

 

Parental relationships may be established when consent is given and medical procedures initiated

Having clarified that the methods in section 7610 are not exclusive, the court held that parental relationship also may be established when medical procedures are initiated and consented to by the intended parents, even when there is no genetic relationship between them and the child. The basis for this groundbreaking holding are found in section 7610, section 7613 and basic common law estoppel principles.

 

First, as already discussed, section 7610 does not provide an exclusive choice of methods to establish a parental relationship. Apparently, the court is willing to expand the list of methods to keep up with technology, despite the absence of explicitly supporting legislative history: "[C]ourts must construe statutes in factual settings not contemplated by the enacting legislature." (quoting Johnson v. Calvert, 5 Cal.4th 84, 89 (1993).

 

Second, the court relies on section 7613 of the UPA: "If, under the supervision of a licensed physician and surgeon and with the consent of her husband, a wife is inseminated artificially with semen donated by a man not her husband, the husband is treated in law as if he were the natural father of a child thereby conceived." The focal point of this section is "consent". In the case at hand, a gestational surrogate was implanted with the genetic material of unknown donors. The statute explicitly covers a woman who is implanted with the semen of one other than her husband. Despite the obvious dissimilarities, the court focuses on the intent to procreate, which is present in both situations: "Both contemplate the procreation of a child by the consent to a medical procedure of someone who intends to raise the child but who otherwise does not have any biological tie. . . . If a husband who consents to artificial insemination under section 7613 is ‘treated in law' as the father of the child by virtue of his consent, there is no reason the result should be any different in the case of a married couple who consent to in vitro fertilization by unknown donors and subsequent implantation into a woman who is, as a surrogate, willing to carry the embryo to term for them. The statute is, after all, the clearest expression of past legislative intent when the legislature did contemplate a situation where a person who caused a child to come into being had no biological relationship to the child."

 

Third, under common law estoppel principles, exemplified in the case of People v. Sorenson, the court states that "[b]y consenting to a medical procedure which results in the birth of a child – which the Sorenson court held establishes parenthood by common law estoppel – a husband incurs the legal status and responsibility of fatherhood." (citing People v. Sorenson , 68 Cal.2d. 280 , 285 (1968)). The court uses this as a basis by expanding the Sorenson decision to include establishing maternity, and by reading the case in conjunction with section 7613, which has its roots in Sorenson. Accordingly, under the second and third bases for its ruling, the court states that both parents may establish parenthood based on their consent to a medical procedure intended to bring a child of their own into the world.

 

Court establishes legal "mother" in surrogacy agreements

Further, the court is careful to point out the compelling state interest in avoiding a "parentless" child situation, not burdening taxpayers, and establishing paternity, as explicitly stated in UPA section 7570(a). The court states that theJohnson v. Calvert case clearly precludes a court from declaring the surrogate or an egg donor the legal parents of a child conceived from a surrogacy arrangement. Thus, not only is the decision to analyze maternity the same as paternity under the UPA, as explained above, logical, but it also avoids the question as to who is the legal mother of the child.

 

Accordingly, the court ruled the parental relationship between the Buzzancas and Jaycee was established by evidence that medical procedures were initiated and consented to by Buzzancas, even though neither was genetically related to Jaycee, and Luanne did not give birth to her. As the court quotes Professor Hill, a legal commentator on the subject, the intended parents are the "first cause, prime movers, of the procreative relationship."

 

Paternal responsibilities established

The court rejected John's arguments that the contract was not signed before the procedure, and that Luanne promised to assume all responsibility for Jaycee's care. First, the court briefly acknowledged the first argument, stating there was an agreement, despite that it was not in writing before the implantation. Second, the court emphasized that even if Luanne promised to assume all responsibility for Jaycee's care, he is nevertheless the father and may not avoid his financial responsibilities. It stated that the law is clear: "parents cannot, by agreement, limit or abrogate a child's right to support." John, who engaged in "procreative conduct", was established as Jaycee's father, and as such was responsible for her support.

 

Although the court has clarified important issues in regards to surrogacy arrangements, it recognizes the need for legislative action to sort out the parental rights and responsibilities arising out of assisted reproductive technologies, as the UPA is "imperfectly designed."

 

Stage set to replace costly step-parent adoptions with pre-birth judgments

The ramifications of this case are potentially ground-breaking. If one was to expand the holding to cover traditional surrogacy arrangements, one could conclude that because the medical procedures would be initiated and consented to by the intended parents, maternity may be established through a judgment, rather than a step-parent adoption. This is because it could be established by a manner other than those listed in section 7610; adoption being the only option for an intended mother who neither gives birth or uses her genetic material. If one utilizes section 7613 to establish maternity, then the intended mother's consent to the insemination of her husband's sperm into a surrogate would require a simple pre-birth judgment of maternity and paternity to establish her parenthood. Even more fundamentally, the Court's decision signals the possible departure from previously accepted dogma that traditional surrogacy is, and must be, treated differently from gestational surrogacy. Expansion of the Calvert v. Johnson "intent of the parties" approach to traditional surrogacy, will permit otherwise financially strapped infertile couples the opportunity to avail themselves of surrogacy and enjoy the same legal protections as those couples who utilize gestational carriers.

 

It was once urged that when intended parents have no genetic relation to the child, the child is to be "parentless" and the state's responsibility. Now, at least California has enunciated a rule of law that will help avoid such situations; a rule progressive enough to encompass current and anticipated future medical technologies. Equally important, the Buzzanca court has extended comprehensive legal protection to couples considering the use of donated gametes, including oocytes and embryos, in an area which, heretofore, represented a legal black hole. In so doing, California has reasserted its position as arguably the most favorable jurisdiction in the world for infertile couples contemplating the use of assisted reproductive technologies.

March 11, 1998

 

 

*EDITOR'S NOTE:

 

Following the publication of this article, the authors were successful in petitioning the Los Angeles Superior Court for a Judgment of Maternity on behalf of an Intended Mother, who along with her husband (the biological father), worked with a traditional surrogate. The Judgment of Maternity, issued on March 17, 1998, permitted the Intended Mother to finalize her parental rights without having to undergo a step-parent adoption.

 

Consequently, it will no longer be necessary for an Intended Mother to pursue a step-parent adoption and the legal, financial and administrative hardships typically associated with step-parent adoptions. Rather, all Intended Parents can now finalize their parental rights through a Judgment of Maternity & Paternity (in most cases, prior to the birth of their child) regardless of whether they use a traditional or gestational surrogate. This procedure will also allow the initial birth certificate to be issued in the names of the Intended Parents, obviating the need to secure an amended birth certificate.

The elimination of the disparate treatment historically associated with traditional surrogacy will hopefully encourage more couples to consider assisted reproduction as a viable option to begin their families.

 

 

Pregnancy Discrimination Act and How to File

Facts About Pregnancy Discrimination
The Pregnancy Discrimination Act is an amendment to Title VII of the Civil Rights Act of 1964. Discrimination on the basis of pregnancy, childbirth or related medical conditions [including infertility or reproductive failure] constitutes unlawful sex discrimination under Title VII. Women affected by pregnancy or related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations.

 

Hiring
An employer cannot refuse to hire a woman because of her pregnancy related condition as long as she is able to perform the major functions of her job. An employer cannot refuse to hire her because of its prejudices against pregnant workers or the prejudices of co-workers, clients or customers.

 

Pregnancy and Maternity Leave
An employer may not single out pregnancy related conditions for special procedures to determine an employee's ability to work. However, an employer may use any procedure used to screen other employees' ability to work. For example, if an employer requires its employees to submit a doctor's statement concerning their inability to work before granting leave or paying sick benefits, the employer may require employees affected by pregnancy related conditions to submit such statements.

 

If an employee is temporarily unable to perform her job due to pregnancy, the employer must treat her the same as any other temporarily disabled employee; for example, by providing modified tasks, alternative assignments, disability leave or leave without pay.

 

Pregnant employees must be permitted to work as long as they are able to perform their jobs. If an employee has been absent from work as a result of a pregnancy related condition and recovers, her employer may not require her to remain on leave until the baby's birth. An employer may not have a rule which prohibits an employee from returning to work for a predetermined length of time after childbirth.

 

Employers must hold open a job for a pregnancy related absence the same length of time jobs are held open for employees on sick or disability leave.

 

 

 

******** HEALTH INSURANCE**********

Any health insurance provided by an employer must cover expenses for pregnancy related conditions on the same basis as costs for other medical conditions. Health insurance for expenses arising from abortion is not required, except where the life of the mother is endangered.

 

Pregnancy related expenses should be reimbursed exactly as those incurred for other medical conditions, whether payment is on a fixed basis or a percentage of reasonable and customary charge basis.

The amounts payable by the insurance provider can be limited only to the same extent as costs for other conditions. No additional, increased or larger deductible can be imposed.

 

Employers must provide the same level of health benefits for spouses of male employees as they do for spouses of female employees.

 

Fringe Benefits
Pregnancy related benefits cannot be limited to married employees. In an all-female workforce or job classification, benefits must be provided for pregnancy related conditions if benefits are provided for other medical conditions.

 

If an employer provides any benefits to workers on leave, the employer must provide the same benefits for those on leave for pregnancy related conditions.

Employees with pregnancy related disabilities must be treated the same as other temporarily disabled employees for accrual and crediting of seniority, vacation calculation, pay increases and temporary disability benefits.

 

 

See also: How To File A Charge of Employment Discrimination

 

States Mandating Insurance Coverage for Infertility and Pregnancy Loss

Arkansas

This law requires all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF) Health maintenance organizations, commonly called HMOs, are exempt from the law.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
  • The patient's eggs must be fertilized with her spouse's sperm;
  • The patient and her spouse must have at least a two-year history of unexplained infertility,
  • OR the infertility must be associated with one or more of the following conditions:
    • Endometriosis;
    • Fetal exposure to diethylstilbestrol, also known as DES;
    • Blocked or surgically removed fallopian tubes that are not a result of voluntary sterilization; or
    • Abnormal male factors contributing to the infertility.

 

The IVF benefits are subject to the same deductibles and co-insurance payments as maternity benefits. The law also permits insurers to limit coverage to a lifetime maximum of $ 15,000.

(Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118).

 

Maryland

The Maryland law requires health and hospital insurance policies that provide pregnancy benefits to also cover the cost of in-vitro fertilization. However, the law does not apply to health maintenance organizations, or HMOs. Policies that must provide the coverage include those covering people who live and work in the state, regardless of whether the policy is issued in or outside the state.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient's eggs must be fertilized with the sperm of the patient's spouse;
  • The patient is unable to get pregnant through less expensive covered treatments;
  • The IVF is performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
  • The patient and his or her spouse must have at least a five-year history of infertility;
  • OR their infertility must be associated with one or more of the following conditions:
    • Endometriosis;
    • Fetal exposure to diethylstilbestrol, also known as DES; or
    • Blocked or surgically removed fallopian tubes.

 

Regulations that took effect in 1994 exempt businesses with 50 or fewer employers from having to provide the IVF coverage.

(Annotated Code of Maryland, Article 48A, Sections 354DD, 470W and 477EE).

 

Massachusetts

This state's law requires health maintenance organizations and insurers companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment.

The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."

Benefits covered include:

 

  • Artificial insemination;
  • In vitro fertilization;
  • Gamete Intrafallopian Transfer;
  • Sperm, egg and/or inseminated egg retrieval, to that extent that those costs are not covered by the donor's insurer;
  • Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility; and
  • Zygote Intrafallopian Transfer (ZIFT).
  •  

Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs.

(Annotated Laws of Massachusetts, Chapters 175,@ 47H; 176A,@8K;176B,@4J; and l76G,@4).

 

Montana

This state's law requires health maintenance organizations (Blue Cross Blue Shield is the only one in Montana) to cover infertility services as part of basic preventive health care services.

The law does not define infertility or the scope of services covered; nor did the state ever draft regulations explaining what infertility services entail. As for health insurers other than HMOs, the law specifically excludes infertility coverage from the required scope of health benefits those insurers must provide.

(Montana Code Annotated, Sections 33-22-1521 and 33-31-102)

 

New York

The New York law requires insurers to cover the diagnosis and treatment of correctable medical conditions and makes clear that coverage cannot be withheld for a correctable condition solely because the condition results in infertility.

 

However, the law DOES NOT require coverage for the reversal of voluntary sterilization, experimental procedures, or procedures intended solely to produce pregnancy - like IVF.

(New York Consolidated Laws, Insurance, Sections 3216, 3221 and 4303).

 

Ohio

Ohio's law requires health maintenance organizations to cover basic preventive health services, including infertility

 

The Ohio Insurance Department has no written definition of infertility services, but the following general interpretation is applied to the code:

 

Up to $2,000 worth of infertility services are to be covered if the couple experiences an inability to conceive purely as a result of infertility problems (unexplained infertility, for example). The $2,000 cap is not applied if another condition or medically related problem (endometriosis, for example) is involved. Experimental procedures - determined on a case-by-case basis by the Insurance Department -- are not covered.

(Ohio Revised Code Annotated, Chapter 1742).

 

Rhode Island

The Rhode Island law requires insurers that cover pregnancy services to cover the cost of medically necessary expenses of diagnosis and treatment of infertility.

 

The law defines infertility as "the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year."

 

The patient's co-payment cannot exceed 20 percent (Rhode Island General Laws @ 27-18-30, 27-19-23, 27-20-20 and 27-41-33).

 

Texas

This state's law requires certain insurers that cover pregnancy services to offer coverage for infertility diagnosis and treatment - including in vitro fertilization. Therefore insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
  • The patient's eggs must be fertilized with her spouse's sperm;
  • The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
  • The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
  • The patient and her spouse must have at least a continuous five-year history of unexplained infertility,
  • OR the infertility must be associated with one or more of the following conditions:
    • Endometriosis.
    • Fetal exposure to diethylstilbestrol (DES);
    • Blocked or surgical removal of one or both fallopian tubes; or
    • Oligospermia

 

The law does not require organizations that are affiliated with religious groups to cover treatment that conflicts with the organization's religious and ethical beliefs.

(Texas Insurance Code, Article 3.51-6).

 

Pages