Fertility Coverage
Delaware SB139

On June 30, 2018, the DE Governor signed Senate Bill 139 into law. SB139 is a historic bill that requires health insurance offered in DE to provide infertility treatment coverage. Unfortunately, companies who are self-insured are exempt from the bill; however, many employers are offering infertility benefits even when not required by law.

On August 1, 2019 the State of Delaware expanded its employee benefits. Please contact Patient Accounts (302)738-4600 x19 with any questions on how this expansion allows for additional infertility care

  • Infertility means a disease or condition that results in impaired function of the reproductive system whereby an individual is unable to procreate or to carry a pregnancy to live birth.
  • Iatrogenic infertility means an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
  • Such benefits must be provided to covered individuals, including covered spouses and covered non spouse dependents, to the same extent as other pregnancy-related benefits.
  • Covered individual has not been able to obtain a successful pregnancy through reasonable effort with less costly infertility treatments covered by the policy, contract, or certificate, except as follows:
    • No more than 3 treatment cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered.
    • If IVF is medically necessary, no cycles of ovulation induction or intrauterine inseminations may be required before IVF services are covered.
  • For IVF services, retrievals are completed before the individual is 45 years old and transfers are completed before the individual is 50 years old.

All individual, group and blanket health insurance policies that provide for medical or hospital expenses shall include coverage for fertility care services, including IVF and standard fertility preservation services for individuals who must undergo medically necessary treatment that may cause iatrogenic infertility. Such benefits must be provided to the same extent as other pregnancy-related benefits and include the following:

  • Intrauterine insemination.
  • Assisted hatching.
  • Cryopreservation and thawing of eggs, sperm, and embryos.
  • Cryopreservation of ovarian tissue.
  • Cryopreservation of testicular tissue.
  • Embryo biopsy.
  • Consultation and diagnostic testing.
  • Fresh and frozen embryo transfers.
  • Six completed egg retrievals per lifetime, with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine, using single embryo transfer (“SET”) when recommended and medically appropriate.
  • IVF, including IVF using donor eggs, sperm, or embryos, and IVF where the embryo is transferred to a gestational carrier or surrogate.
  • Intra-cytoplasmic sperm injection (“ICSI”).
  • Medications.
  • Ovulation induction.
  • Storage of oocytes, sperm, embryos, and tissue.
  • Surgery, including microsurgical sperm aspiration.
  • Medical and laboratory services that reduce excess embryo creation through egg cryopreservation and thawing in accordance with an individual’s religious or ethical beliefs.
  • Requires infertility treatment or procedures to be performed at facilities that conform to the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility Guidelines.
  • A policy may not impose restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for required fertility care services, which are different from those imposed upon benefits for services not related to infertility.
  • Experimental fertility care services, monetary payments to gestational carriers or surrogates, or the reversal of voluntary sterilization undergone after the covered individual successfully procreated with the covered individual’s partner are not covered.
  • Does not require religious organizations to provide coverage.
  • Employers who self-insure or who have fewer than 50 employees are exempt from the requirements of the law.