Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 865 - STANDARDS FOR FERTILITY COVERAGE
Section 031-865-5 - Required Benefits
Current through 2024-38, September 18, 2024
Fertility coverage shall include, at a minimum, payment of benefits for the following services and procedures for fertility patients, subject to the limitations permitted by Section 6, when the service or procedure is recognized as medically appropriate, in light of the fertility patient's medical history, under guidelines adopted in compliance with this rule:
1. Intrauterine or vaginal insemination;
2. Assisted hatching;
3. Diagnosis and diagnostic tests;
4. Laboratory testing;
5. Ultrasounds and other imaging procedures;
6. Physical examinations;
7. Fresh and frozen embryo transfer, including the transfer of donor embryos;
8. Egg retrievals, including, when a live donor is used in an egg retrieval, the donor's associated medical costs until the donor is released from treatment by the reproductive endocrinologist; covered medical costs include without limitation physical examination, laboratory screening, psychological screening, prescription drugs, monitoring follicle development, the retrieval procedure, and treatment of any direct medical complications of covered procedures;
9. Gamete intrafallopian tube transfer and zygote intrafallopian tube transfer;
10. Intracytoplasmic sperm injections;
11. In vitro fertilization, including in vitro fertilization using donor eggs and in vitro fertilization where the embryo is transferred to a gestational carrier or surrogate;
12. Medications, including injectable fertility medications, even if the contract or policy does not provide prescription drug benefits. Where a contract or policy provides both prescription drug and medical and hospital benefits, fertility drugs shall be covered under the prescription drug coverage;
13. Ovulation induction;
14. Surgery, including but not limited to microsurgical sperm aspiration or extraction; and
15. Costs associated with cryopreservation and storage of embryos, eggs, sperm, ovarian tissue, and testicular tissue for up to five years.
