Illinois Family Building Act

Most of the citizens of Illinois are entitled by law to fertility care according to the "Illinois Family Building Act of 1991." If you are unable to conceive after one year of unprotected sexual relations between a male and a female or are unable to sustain a successful pregnancy, you may be entitled to fertility care.

What are the fertility services benefits according to the law?
Fertility benefits include appropriate evaluation and treatment. If you did not conceive with regular fertility care, you are entitled to a maximum (lifetime) of four IVF egg retrievals to achieve the birth of a child. Once delivery of an IVF baby occurs, you are entitled to two additional IVF egg retrievals.

Who benefits from this law?
Insurance companies have to offer your employer a policy covering fertility services. Your employer may or may not incorporate fertility care in the company’s policy. If you are a member of an employee group that is larger than 25, your employer must provide you with fertility benefits.

Employer does not have to provide fertility benefits to you if:

  1. Your employer finances your health care without buying a policy from an insurance company (self-insured).
  2. Your company is headquartered outside of Illinois.
  3. Your group insurance policy was bought through a trust outside of Illinois.
  4. Your employer is a religious institution or organization in which some or all fertility procedures may violate your employer’s religion or beliefs.
  5. You or your spouse voluntarily sterilized yourselves without attempting to reverse the sterilization.
  6. You have already completed four IVF egg retrievals without a successful birth.
You have completed two or more IVF egg retrievals following the birth of your first IVF baby.

Will an HMO option cover my treatment?
Many HMO’s that are licensed in Illinois have to cover fertility treatments, even if there are less than 25 employees. This can often be a beneficial option for couples who are offered HMO’s as an insurance benefit option. The downside is that you may have to seek services from the physicians who have contracted with that particular HMO.

If my covered cycles have been used, can I switch insurances?
You may change your insurance but it may no longer cover your treatment expenses. The Family Building Act is a lifetime benefit. The insurer is not required to cover any additional cycles. It is only done at its discretion. You may want to discuss this with the insurer prior to changing insurance. As always, get the statement in writing.

What can I do if my company does not offer fertility benefits?
It is important to discuss this directly with the Human Resources Department or Benefit Plan Administrator. Every company today needs to retain good employees in today’s economy. A simple request may lead it to consider adding coverage to its benefit package. A recent Supreme Court decision stated that reproduction is a major life activity and may be covered under the Americans with Disabilities Act (ADA). Another recent Equal Employment Opportunities Commission ruling in the New York District Office also has asserted that infertility is covered under the ADA. You may try to fight for coverage on your own or with the help of a lawyer. There are time limits under which you may appeal a claim or file charges. A lawyer with experience in this area can help you assert your rights.

 

To read more about the Illinois State Mandate, please view this document: Illinois Insurance Facts