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| Job and Health Insurance |
 Question
Is my employer required to cover my infertility treatments? If not, how do I find an insurance company in my state that will?
Answer
Whether or not your employer must cover the costs of the diagnosis and treatment of your infertility depends on your state's insurance laws. Some states require that health insurance plans provide infertility coverage, while other states say they must simply offer it to the plan buyer. That's a delicate but significant distinction, not just a matter of semantics. A mandate to provide with coverage means that employers get to select whether they want to buy that coverage from the insurance company for extra money.
If your employer isn't required to cover infertility treatment and doesn't offer it voluntarily, there's no easy way to find such coverage as an individual. In general, you might not be able to find it at all. Because treatment is so expensive — upwards of $10,000 for one in-vitro fertilization attempt, insurers are reluctant to include infertility coverage in health plans for individuals. Resolve is an advocacy group which is pushing for federal legislation that will require each state to adopt infertility treatment laws.
Question
My employer offers health insurance through an HMO, but it's not available to all the employees. Is that legal?
Answer
It is perfectly legal, although it might not sound fair. Employers are allowed to define which classes of employees, if any, are offered a health plan. For example, a manufacturing plant can choose to offer a health plan to executive employees or managers and not to shop floor workers. Nevertheless, all of the employees in the designated class must be offered the health plan; the employer cannot offer the health plan only to select employees in that designated class.
Besides, once an HMO or insurance company extends an offer of coverage to an employer, no employee in that class can be excluded from coverage simply because he or she has health problems. The health plan can screen the health history of the individual employees in the group, but only to define whether it will accept or reject the entire group for coverage or what group premium to charge.
When it comes to small employer group coverage, a lot of states now require "guaranteed issue," which means an insurance company or HMO cannot refuse to cover a group, even if one or more employees or their dependents have health problems. It is possible to review the health status of the employees, but only to set the premiums for the group.
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