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Conn. law limits age for infertility coverage

A new Connecticut law denies insurance coverage for fertility treatments for women over 40.
Jim LeRuo, 44, and and his wife, Teresa Pica-LeRuo, 42, are hoping that the Connecticut law will change for infertile couples. The law, which goes into effect Oct. 1, makes Connecticut the only state to deny insurance benefits to 40-year-olds and women's advocates are concerned that more states will follow suit. Douglas Healey / AP
/ Source: The Associated Press

Teresa Pica-LeRuo thought her dreams of becoming a mother would finally come true this year.

She and her husband, Jim, have been trying for years to have a child. They attempted infertility treatments. Then they adopted a child, but were devastated when the birth mother took the infant back.

Pica-LeRuo pinned fresh hopes on a new state law requiring insurers to pay for infertility treatments. But the law is the only one in the country that denies benefits to women older than 40, and she won’t qualify. Pica-LeRuo is 42.

“I feel like I’m being punished,” said Pica-LeRuo, who lives in this south-central Connecticut town. “I’m not ready to say I’m not going to be a mother.”

Connecticut is the 15th state to enact a law requiring some type of infertility coverage. There is no federal law requiring coverage. Most states don’t have age limits, although New York cuts off coverage at 44 and New Jersey ends coverage at 46. Women’s advocates are concerned that other states will follow Connecticut’s lead.

“We’d rather that be left up to the patient and their physician,” said Julie Salz Greenstein, director of government relations for Maryland-based RESOLVE: The National Infertility Association.

Research shows that as women reach their mid-30s, the success rate for assisted reproductive technology declines. A January Centers for Disease Control and Prevention report shows that 37 percent of women younger than 35 who used their own eggs in treatment had a successful pregnancy. Between ages 38 to 40, the success rate fell to 21 percent. For women older than 42, it was 4 percent.

The age cutoff was a compromise on a hotly contested bill. The insurance industry argued that the expensive, high-stakes treatments would ultimately drive up health care costs. For example, one round of in vitro fertilization typically costs $12,000, and couples often have to try multiple times to become pregnant.

“Really, the rationale was a need to figure out a way to manage the significant cost implications of this mandate and try to cover the treatment where it was most likely to produce the best results,” said Keith Stover, a lobbyist for the Connecticut Association of Health Plans.

RESOLVE plans to lobby to change the age restriction when lawmakers reconvene in February. One of the law’s proponents said he also hopes to set a higher age limit.

“I always felt it was a little too low. But at the same time, we were coming really close to having nothing at all,” said Rep. Chris Perone, D-Norwalk.

Limits number of embryos
The legislation, which goes into effect Oct. 1, requires most individual and group insurers to cover a lifetime maximum cost of two in vitro fertilization cycles, three intrauterine insemination cycles, and four ovulation induction treatments per patient. The law does not apply to employees in self-insured plans. There is no age limit for men participating in infertility procedures.

Connecticut’s law also is the only one in the country to limit the number of embryos that can be implanted in a woman’s uterus to two for each in vitro fertilization treatment. The goal is to reduce the number of possible multiple births.

Pica-LeRuo and her husband said they can’t afford in vitro fertilization on their own and her employer changed health insurance carriers to one that does not cover infertility treatments. Though she wants Connecticut lawmakers to remove the age limit, she is considering changing jobs and moving to New York to get coverage.

“The reality is, women over 40 can’t wait,” she said. “We can’t wait for the new session to start.”