Should insurance plans include infertility services?Should insurance plans include infertility services?

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dkaye eNotes educator| Certified Educator

I'll float one proposal for how it might work, though I think it would be too difficult to really execute.

Yes, it should be covered--but within certain parameters. 

The reproductive system is a set of physiological workings just like any other system. When it fails where it should succeed, it should be treated--the same way that respiratory or circulatory problems would be covered by insurance.

Sometimes, infertility can cause depression. In many cases, the costs associated with mental health treatment could be invested more fruitfully in infertility treatments.

On the other hand, this doesn't mean that insurance should be required to pay for treatment people outside normal childbearing age range.  Women normally have a 2030-year window of fertility (though it gets progressively more difficult to conceive as women approach menopause, and studies show that women age 40 have just 3% of the eggs they were born with), and it would be unreasonable to demand that insurance cover treatments for, say, a 60-year-old woman trying to conceive. Likewise, if a doctor determined that age or another problem not related to physical/medical health was at fault for a man's inability to conceive, that shouldn't have to be covered, either.

While this is OK in theory, in practice, it would be difficult and inefficient for insurance companies, relying on doctors, to determine the true underlying causes of infertility in every person or couple tryiing to claim benefits.

Lorraine Caplan eNotes educator| Certified Educator

I'd like to play devil's advocate on this issue.  From a pragmatic point of view, I can certainly see why covering infertility services is a bad idea, and I agree that more infertile people should adopt.   There are so many children in foster care, and as abortion becomes a right increasingly difficult to exercise, more and more unwanted children are being born.  However, infertility is a dysfunction of a major body system, the reproductive system.  If insurance companies are permitted to pick and choose among the dysfunctional body systems they can cover, it is not a stretch to be concerned the exclusion of many forms of coverage we do want.  Diabetes is "merely" a dysfunction of the pancreas, and there is no cure.  Also, there seems to be some inherent inequity in saying that pregnancy and delivery should be covered, since neither of these is a dysfunction, while not covering the inability to have a child.  We spend probably billions of dollars each year on problem pregnancies, problem deliveries, and neo-natal intensive care services.  Is it reasonable to say that some sorts of reproductive coverage are fine and other sorts are not? 

Karen P.L. Hardison eNotes educator| Certified Educator

While this is an very dear topic to those who have infertility as a concern and while one sympathizes with their concern, it seems a little difficult to justify adding infertility treatment to insurance plans. If I understand your use of "insurance plans" correctly, you are speaking of business insurance plans made available to employees. Insurance plans of this sort aim at protecting and treating the health of employees. These are made available partly to promote the continued, uninterrupted productivity of the business and partly to defray medical costs, which is indirectly related to reducing employee salary and wage levels. With this framework and aim in mind, it is difficult to justify adding infertility to such plans as infertility is strictly a private matter that has no bearing on the productivity of the business (in fact, may in some instances indirectly hamper productivity if pregnancy or maternity leave are requested) and as infertility has no direct bearing upon healthful ability to contribute gainful employment.

Kristen Lentz eNotes educator| Certified Educator

I mentioned this in another discussion topic, but I certainly think it is applicable to this discussion as well.  Infertility services should not be included for coverage on insurance plans, but I do think people should have options to provide themselves with that coverage for an extra premium.  If this service were included in all policies it would drive up the cost of insurance for everyone.  Sickness and illness are never chosen, but a pregnancy often is. 

A woman would have to elect the additional premium by a certain age (determined by the insurance company), and so long as those premiums are up to date then infertility treatment could be covered.  This would be very similar to a disability policy.  It might actually be a moneymaker for the insurance companies, and provide a sense of security to people who know that having a family will be a priority they will fight for financially if they have to.  At the same time it wouldn't financially burden people who don't plan on having a family.

thanatassa eNotes educator| Certified Educator

Insurance plans are mainly designed to pay for curing and preventing illnesses. In a time of spiraling medical costs, it is essential that they pay only for procedures which are necessary for health. For example, treating cancer or doing prenatal care are essential, and giving anything less than the best treatment (especially in prevention) can increase downstream costs as well as being inhumane. Fertility treatments, however, are voluntary procedures. People can live perfectly healthy lives without children. Therefore, fertility treatments should be regarded along with other lifestyle choices such as plastic surgery, gender reassignment, etc. as matters that people can pay for themselves but not something other people in the insurance pool should be forced to subsidize.

ask996 eNotes educator| Certified Educator

Perhaps what we should look at is whether infertility poses a health risk as a result of the dysfunction. The examples being used in previous posts diabetes, pregnancy, neonatal problems would pose a health risk if treatment were not covered. The purpose of insurance is to cover preventative procedures so that health risks or more serious health risks do not occur and to cover medical situations (pregnancy) after they occur to ensure further health complications are minimized. As heartbreaking as infertility might be, it should not be covered by insurance unless it creates a current or future health risk.

pohnpei397 eNotes educator| Certified Educator

This depends on what you mean by "should."  Yes, it would be nice if they did.  Infertility is a heartbreaking condition for many people.  I know a couple whose extended family is trying to raise at least $10,000 for them through bake sales and such because they cannot conceive.  However, this does not necessarily mean that insurance plans should be required to provide this coverage.  Infertility treatments are, as the previous post points out, elective procedures that are not critical for the anyone's actual health.  Therefore, it does not make sense to require that these treatments be covered.

litteacher8 eNotes educator| Certified Educator

I do not think insurance plans should include infertility services.  Infertility may be caused by medical conditions, but it is not a medical condition.  Infertility therapies are very expensive, and many don't work.  I wish they were cheaper, and certainly feel the pain of a couple trying to conceive a child.  However, adoption is a better option.