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Fertility Treatment: Can Health Insurance Discriminate Against Unmarried?

Imagine that you have health insurance coverage, but your insurance company requires that you be married to use it.

This week is National Infertility Awareness Week. Thirteen states have laws that require health insurance companies to cover some fertility treatments. Two more states require small group health insurance to offer infertility coverage. Unfortunately, in five of these states the laws only require the insurance company to offer or cover infertility treatments if a woman is using her husband’s sperm. This means that unmarried heterosexual couples, single women, lesbian couples, and anyone with male factor infertility can be legally denied a health benefit that is available to others who pay the same premiums. 

Take Marsha Greene. Marsha is divorced and cohabits with her male partner, who is also divorced. They’d been trying to get pregnant when a doctor discovered that Marsha, who is 33, has diminished ovarian reserves. This means that her eggs don’t release every month, and that even when they do, they may be weaker than other women’s eggs. 

Her doctor recommended intrauterine insemination (IUI), which involves stimulating the release of eggs and inserting sperm into the uterine cavity during ovulation. If that doesn’t work, they would move on to in vitro fertilization (IVF), where eggs are removed, fertilized in the lab, and the fertilized eggs are inserted into the uterus. Though Marsha pays insurance premiums for a plan that includes coverage for IVF, the company policy is to deny her coverage for the procedure unless she marries her partner, the sperm donor. 

Or take Gail (name changed). Gail, who is unmarried, had already started receiving infertility treatments using her employer provided coverage when she came to work for the federal government. She checked her new insurance options and chose a plan based on fertility treatment being partially covered. Five days into treatment, she was told that she had to be married and using her husband’s sperm to qualify for the benefit. Gail paid $14,000 for the exact same treatment for which a married woman with the exact same insurance policy would have paid $5,500.

These companies can deny treatment to Marsha and Gail because Maryland is one of the states where the law only requires insurance companies to pay if the sperm donor is also the husband. So both the law and the insurance companies have decided that based on their marital status, and not their health problems, insurance won’t pay for their medical treatment.

This is discrimination by both the state laws, which don’t require that equal treatment be provided to anyone paying the premium, and by the insurance companies, which choose not to cover a procedure for some of their clients that they cover for other clients with the same medical needs. States should move forward in requiring health insurance companies to cover infertility, but neither the state nor insurance companies should be making decisions about who is entitled to have children and who is not. Equal premiums should result in equal available benefits.


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