Montana health plans would cover infertility diagnosis and treatment

Covered plans would cover infertility diagnosis and treatment, including IVF, which fertilizes eggs outside the body. Coverage would apply to Montana individual and small- and large-group medical or hospital insurance, plus state employee health plans. Insured spouses and other insured dependents would be included. Eligibility would require a physician's findings, a life-threatening genetic disease in the woman or her partner, or failure to become pregnant or carry a pregnancy to live birth despite regular, unprotected intercourse for 12 months for women under 35 or six months for women 35 or older. People who had voluntary sterilization would be excluded. A licensed physician would direct procedures and medicines consistent with established medical practices or the named professional guidelines. Plans would provide at least $25,000 in lifetime coverage for fertilization services. The proposal specified policies, contracts, and health benefit plans issued, delivered, amended, or renewed in Montana on or after October 1, 2025.

Insurers would apply the same patient costs and coverage restrictions to infertility care as to other covered care, except as allowed by the coverage section. These rules would cover infertility diagnosis and treatment, including IVF, under the insurance policies covered by the proposal. Fertility medicines could not face different restrictions from other prescription medicines. Plans could not restrict fertility services because the insured person participated in services provided by or to someone else. The coverage section's lifetime benefit rule would remain allowed. The proposed rules would apply to policies, contracts, and health benefit plans issued, delivered, amended, or renewed in Montana on or after October 1, 2025.