Benefits Café is an insurance agency, staffed by experienced, licensed agents who assist small and mid-sized companies in California with their employee benefits. We advise clients on medical insurance plans and can assist with adding an infertility benefit rider to an existing plan. We would need to be your “broker of record” which is as easy as sending a letter to the insurance company that informing them that you want Benefits Café to be the agent on your medical insurance plan. There is no cost for our services as the insurance companies pay us and you pay the exact same rates with or without a knowledgeable agent such as BenefitsCafe.com. Give us a call to discuss (800)746-0045.
Is infertility covered in California?
Treatment for Infertility is not a covered benefit on standard small group medical insurance plans. Employers can purchase a “rider” or extra coverage that includes infertility benefits. The riders have very specific limits to the range of infertility treatment services that the insurance will pay for. In-vitro fertilization is excluded from most coverage for small businesses in California.
Is infertility an essential health benefit?
No. The diagnosis and treatment of Infertility is not an essential health benefit. The Affordable Care Act (ACA, Obamacare) requires that all small group medical insurance include ten essential health benefits, including items such as emergency service, in and out of hospital services, and prescription medicine. Some states mandate that insurance companies include treatment for infertility. California is not one of those states. California requires that insurance companies “offer” coverage, which costs extra, is expensive and the benefits are very limited.
Does Anthem Blue Cross California cover infertility?
Anthem Blue Cross of California offers an infertility “rider” which is additional coverage at an extra cost. As described in our comprehensive overview of infertility benefits, Anthem’s coverage is very expensive at $90/month for every subscriber (including employee, spouse, children) and the benefit is limited to 50% of covered services with a $2,000 lifetime maximum. Anthem does include in-vitro fertilization as a covered benefit however.
What is fertility reimbursement?
Fertility reimbursement refers to plans that an employer would set up to reimburse an employee for medical expenses incurred to assist with reproduction services. Typically, the employer sends money to an employee after receiving evidence that an infertility service has been obtained an paid for. These arrangements are done on an after-tax basis, which means that the employee must pay taxes on the money received from the employer. Infertility arrangements do not involve an insurance company as it is between the employee and the employer.
How do I ask my employer for fertility benefits?
Before you approach your employer about offering benefits for the diagnosis and treatment of infertility, you may want to understand the options that are available to an employer. Large employers with hundreds or thousands of employees have many more insurance options than small employers in California with fewer that 100 employee. BenefitsCafe.com has summarized the options from insurance companies for small employers and there are links to large employer sites also. It may be that asking your employer to reimburse your out-of-pocket expenses for infertility services is a better option, particularly if you work for a small employer in California.
What are infertility benefits?
Infertility benefits in insurance plans include services to diagnose the cause of the inability to conceive a child and treatments for that condition. Some of the treatments include drug treatment and surgical repair of reproductive organs. Some of the treatments, such as in vitro fertilization (IVF) include collecting sperm an combining it with an egg and inserting the embryo into the womb.
Are fertility benefits taxable?
In 2021 the IRS issued a Private Letter Ruling 202114001 which specified which infertility services were tax deductible. Generally, the IRS found that treatment for a medical condition was a deductible expense while expenses for a surrogate mother are not. IRS Publication 502 has guidance on the tax deductibility of various medical procedures and regarding fertility services states that:
You can include in medical expenses the cost of the following procedures performed on yourself, your spouse, or your dependent to overcome an inability to have children.
- Procedures such as in vitro fertilization (including temporary storage of eggs or sperm).
- Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children.
- Is IVF covered in small business medical insurance?
In California, only Anthem Blue Cross includes IVF in it’s infertility rider. The cost to add the rider is very high, however, and may cost more than the benefits one may receive. Anthem charges $90 per subscriber per month. A subscriber includes every employee, spouse and child enrolled in the medical insurance plan.