Maternal and Child Health Journal

, Volume 23, Issue 5, pp 623–632 | Cite as

US State-Level Infertility Insurance Mandates and Health Plan Expenditures on Infertility Treatments

  • Sheree L. BouletEmail author
  • Jennifer Kawwass
  • Donna Session
  • Denise J. Jamieson
  • Dmitry M. Kissin
  • Scott D. Grosse


Objectives We aimed to examine the extent to which health plan expenditures for infertility services differed by whether women resided in states with mandates requiring coverage of such services and by whether coverage was provided through a self-insured plan subject to state mandates versus fully-insured health plans subject only to federal regulation. Methods This retrospective cohort study used individual-level, de-identified health insurance claims data. We included women 19–45 years of age who were continuously enrolled during 2011 and classified them into three mutually exclusive groups based on highest treatment intensity: in vitro fertilization (IVF), intrauterine insemination (IUI), or ovulation-inducing (OI) medications. Using generalized linear models, we estimated adjusted annual mean, aggregate, and per member per month (PMPM) expenditures among women in states with an infertility insurance mandate and those in states without a mandate, stratified by enrollment in a fully-insured or self-insured health plan. Results Of the 6,006,017 women continuously enrolled during 2011, 9199 (0.15%) had claims for IVF, 10,112 (0.17%) had claims for IUI, and 23,739 (0.40%) had claims for OI medications. Among women enrolled in fully insured plans, PMPM expenditures for infertility treatment were 3.1 times higher for those living in states with a mandate compared with states without a mandate. Among women enrolled in self-insured plans, PMPM infertility treatment expenditures were 1.2 times higher for mandate versus non-mandate states. Conclusions for Practice Recorded infertility treatment expenditures were higher in states with insurance reimbursement mandates versus those without mandates, with most of the difference in expenditures incurred by fully-insured plans.


In vitro fertilization Infertility Artificial insemination Assisted reproductive technologies Ovulation induction Expenditures Insurance 


Supplementary material

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Supplementary material 1 (DOCX 18 KB)
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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sheree L. Boulet
    • 1
    Email author
  • Jennifer Kawwass
    • 1
    • 2
  • Donna Session
    • 3
  • Denise J. Jamieson
    • 1
  • Dmitry M. Kissin
    • 2
  • Scott D. Grosse
    • 4
  1. 1.Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaUSA
  2. 2.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Division of Reproductive Endocrinology and InfertilityVanderbilt University School of MedicineNashvilleUSA
  4. 4.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA

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