Yes, Health New England covers infertility services in accordance with Massachusetts and Connecticut mandates. Infertility is defined as the inability to conceive for a period of at least one year if under age 35, and six months if over age 35.
What infertility treatments are covered?
Depending on the causes of infertility, there are some first-line treatments that may be appropriate. These do not require prior approval. They may include surgery, drug treatments and/or ovulation induction.
What if the first-line treatments don’t work?
Treatment with one of the Assisted Reproductive Technologies (ART) may be indicated. You must meet eligibility requirements for ART. Prior approval is required for all services.
What are the eligibility requirements for ART?
Complete eligibility requirements for ART are outlined in
Health New England's Infertility Protocol. There are residency requirements and individual plan limitations. Other criteria that must be met include:
- Coverage is only available for individuals under a certain age.
- You and your partner must be non-smokers.
- You must seek a nutrition consult and/or participate in a weight loss program if your BMI is 35 or above.
Why are these criteria important?
These requirements support your health status and your ability to conceive. They also decrease risks to both you and your baby.
Who should I talk to about infertility treatment?
Talk to your doctor. If appropriate, he or she may refer you to an infertility specialist. The specialist will perform an assessment and determine whether infertility treatment is appropriate.
Where can I get more information about my coverage for infertility services?
Make sure you are familiar with your plan and your member materials (also referred to as your Member Handbook, Explanation of Coverage or Summary Plan Description). You can find these online when you log into your account on the member portal at
my.healthnewengland.org. Or, if you prefer, you can call Member Services at (800) 310-2835 for more information.