PD52-08 INEQUITY BETWEEN MALE AND FEMALE INFERTILITY COVERAGE IN STATE INSURANCE LAWS

INTRODUCTION AND OBJECTIVES

The World Health Organization and American Society of Reproductive Medicine (ASRM) define infertility as a disease, and the ASRM, the National Institute for Health and Care Excellence in the United Kingdom, and the Centers for Disease Control and Prevention all recommend that infertile couples begin work-ups together. With the Affordable Care Act silent on federal mandates for infertility coverage, the issue will be left to individual states. While several studies have analyzed female infertility coverage across states, none have evaluated coverage for male infertility. Male-factor infertility alone accounts for 30% of all infertility and is associated with an increased risk of cardiovascular disease, cancer, and early mortality in men. We hypothesize that insurance coverage for male infertility is disproportionately excluded from state insurance laws.

METHODS

We identified states with laws or codes related to infertility insurance coverage using the National Conference of States Legislatures' (www.ncsl.org) and the National Infertility Association's (www.resolve.org) websites. We performed a primary, systematic review and analysis of the laws or codes to specifically identify coverage for male infertility services.

RESULTS

There are 16 states with laws addressing insurance coverage for infertility (Table 1). Only 6 states (37.5%) (CA, CT, MA, NJ, NY, OH) clearly mandate male infertility evaluation or treatment. In two states (WV, MT), infertility coverage is listed only as part of basic health care services but is not further defined. In CA and TX, infertility coverage must be offered to employers, but employers may elect to include or exclude infertility coverage for their employees. Three states (MA, NY, NJ) exempt coverage for vasectomy reversal.

CONCLUSIONS

Despite national recommendations that male and female partners begin infertility evaluations together, only 37.5% of states with laws concerning infertility clearly include coverage for the male partner. Excluding men from infertility coverage places an undue burden on female partners and risks missing opportunities to diagnosis serious male health conditions, correct reversible causes of infertility, and provide cost-effective treatments that can downgrade the intensity of intervention required to achieve a pregnancy.