Infertility treatment age limit repealed in Connecticut to comply with ACA

The existing age limit for mandated coverage of infertility treatment for women, those aged 40 or older, was repealed by Bulletin HC-104 in order to comply with the anti-discrimination mandate in the Patient Protection and Affordable Care Act (ACA), the governor and insurance department commissioner of Connecticut announced.

Guidance issued in 2005, Bulletin HC-64, limited coverage of infertility treatment to women aged 40 and younger, but after the state insurance department undertook a review of the limit, it was determined that infertility treatment may be clinically effective for individuals older than 40. Individuals receiving infertility treatments, an essential health benefit in Connecticut under the ACA, must be healthy and the treatment must be medically necessary to be covered, according to Conn. Gen. Stat. §38a-509 and §38a-536. Male infertility treatment also is covered under the mandate.

The ACA prohibits discrimination in benefit design. Accordingly, the new standards take effect on policies issued or renewed on or after January 1, 2016. The department worked with Connecticut’s health insurers to revise and refine the guidelines, in addition to consulting with the National Women’s Law Center.

SOURCE: Bulletin HC-104, August 13, 2015, and State of Connecticut Press Release, August 13, 2015.

Visit our News Library to read more news stories.