The Difference Between State Mandates to Cover and to Offer Infertility Insurance Coverage

Out of the 15 states that have mandated coverage of infertility in health insurance policies, only California and Texas have mandates to offer coverage in health care policies. What this means to a couple dealing with infertility is that their employer has the option to purchase health insurance that offers some coverage for infertility testing, diagnosis and treatment, but they are not required to buy such insurance.

There are many factors that go into the choice of which insurance policy or policies to purchase and offer to employees, price being one of them. If you live in California or Texas and your employer’s choice of insurance coverage does not include any infertility coverage, you should talk to your human resources manager or the manager of benefits and find out if it would be possible to have the company offer additional health insurance policy options with at least one of them offering infertility coverage.

The company may not want to offer such insurance if their costs will be going up, especially if they believe that only one or two employees want such coverage. So go a little grass roots and find out if your co-workers would be willing to pay more for such coverage, and ask them all to ask for it as an option in future insurance offerings. You may be surprised at how many co-workers would like such coverage and your company may surprise you and offer additional choices in insurance coverage in the future.

That leaves us with 13 states, listed just below along with some information, that have mandates to cover. Depending on the wording of the law for each state, health insurance policies and/or HMOs that offer anything from basic coverage to maternity coverage, must also cover some infertility testing, diagnosis and treatments. Basically, a mandate to cover is just that, they must cover “something” where infertility is concerned and many of the state laws state specifically what must be covered too.

  • Arkansas – HMOs and self-insurers exempt; all individual and group policies that cover maternity must cover
  • Connecticut – Self-insurers and religious organizations exempt; all individual and group policies must cover
  • Hawaii – Self-insurers exempt; all individual and group policies must cover
  • Illinois – Self-insurers, religious employers, and companies with fewer than 25 employees exempt; all group and HMOs that cover pregnancy must cover
  • Louisiana – Self-insurers exempt; cannot exclude coverage just because condition results in infertility
  • Maryland – Self-insurers, religious employers, and companies with fewer than 50 employees exempt; all individual and group policies that cover pregnancy must cover
  • Massachusetts – Self-insurers exempt; all insurers that cover pregnancy must cover
  • Montana – Self-insurers exempt; HMOs required to cover as basic health care
  • New Jersey – Self-insurers, religious employers, and companies with fewer than 50 employees exempt; group insurers and HMOs that cover pregnancy must cover
  • New York – Self-insurers exempt; group policies must cover testing and diagnosis
  • Ohio – Self-insurers exempt; HMOs required to cover as basic health care
  • Rhode Island – Self-insurers exempt; individual and group policies and HMOs that cover pregnancy must cover
  • West Virginia – Self-insurers exempt; HMOs required to cover as basic health care

A state mandate to cover means that unless a business’s group, and in some cases individual, health care insurance is exempt, some form of infertility coverage must be included in the policy. On the flip side of the issue is the state mandate to offer, which only means that the insurance company has to offer for sale a policy that includes infertility coverage, but the business is not required to purchase that coverage. Knowing not only what your insurance policy states is covered, but also what your state’s mandate is, can help you when navigating the world of infertility and insurance coverage.

Learn About Basic and Optional Life Insurance Coverage

FEGLI comes with two types of coverage – Basic and Optional. Whether the employee is covered under CSRS (the Civil Service Retirement System) or FERS (Federal Employees Retirement System) the coverage is identical for FEGLI. While Basic FEGLI coverage is automatically issued in the employee’s name as soon as they start working, the employee will likely want to elect one of more of the three optional coverage choices that are available. The type and amount of any optional coverage that you select and which federal retirement benefits you choose to keep will be based on whichever best fit your needs and as you age and your family circumstances change your selections may also change. Both full time and part time federal employees can participate in the FEGLI program, however, it is voluntary and the plan can be cancelled if you are able to find cheaper life insurance coverage or if don’t require insurance at that moment.

The Basic Insurance Coverage

The Basic Insurance Coverage under FEGLI is automatically issued in the employee’s name as soon as service begins, unless the employee waives the coverage, and acts as immediate protection for the employee’s beneficiaries in the event of death.

• The total amount for this federal employee life insurance is a sum of the employee’s annual basic pay rounded up to the next $1000 plus an additional $2000.

• Two thirds of the costs of this insurance is paid by the employee while the rest is paid by the Government.

o U.S. Postal Service pays 100% of the Basic FEGLI costs for Postal employees. Any Optional Insurance selected is paid for by the employee.

The Optional Insurance Coverage

Apart from the Basic plan, there are three optional federal employee life insurance plans that you can elect under FEGLI. However, you must have basic insurance in the first place to go for any of these options. The cost of this coverage depends upon your age and is payable by you alone without any contribution by the government.
Here are the three types of optional coverage you can go for:

Option A – Standard Optional Insurance

• This coverage amounts to a total of $10,000.

• The cost is decided as per your age, and specific age bands are defined which spell out the costs to each participant.

Option B – Additional Optional Insurance

• While Option A comes with a fixed amount of coverage, option B comes in five multiples (1, 2, 3, 4 or 5) of your annual pay (after being rounded up to the nearest next $1000).

• The cost for this insurance too depends upon the age bands defined at 35, 40, 45, 50, 55, 60, 65, and 70.

o Option B coverage is attractive especially for younger employees. As you age, however, you should always compare your FEGLI costs against other, private, term life insurance options. A huge potential cost savings can be realized if you are already 45 or older or if you intend to protect your family with life insurance beyond 50 years of age. We highly recommend the use of a FEGLI Calculator that can give you an accurate description of your FEGLI rates compared to other term life insurance options.

Option C – Family Optional Insurance

• This type of group term insurance program provides coverage for your family i.e. your spouse and any dependent children. The coverage is decided in the multiples of 1, 2, 3, 4, or 5 as per your choice.

• The multiples are equal to $5000 for your spouse and $2,500 for the eligible children. For example, if you selected a multiple of 4, you will receive $20,000 in case of death of spouse and $10,000 in the event of death of any child.

• The cost of this insurance is decided as per your age not of your family member(s). The same age bands are used for allocating the total costs.
Aside from Basic FEGLI, FEGLI Option A, FEGLI Option B and FEGLI Option C, eligible federal and postal employees are also offered additional benefits such as the Accidental Death and Dismemberment Benefit, Basic Life Extra Benefit and much more.

In case of your accidental death or dismemberment, the coverage of both Basic and Option A federal employee life insurance are doubled. On the other hand, the Basic Life Extra Benefit doubles your basic insurance amount payable if your age is less than 35. This benefit decreases by 10% with every passing year, finally stopping at the age of 45.

Do You Have Sufficient Auto Insurance Coverage?

Imagine getting ready to leave your house and you open your door and the rain is pouring down. Now you start to frantically look for your umbrella…. ah, there it is! You step outside, open your umbrella, and you are now protected from that pouring rain. If it were a bright sunny day with no rain in sight you probably would not even care about where your umbrella is or if you even had one! The same is true about insurance. Until you need it, do you really care about it? Unfortunately, too many people realize that they have insufficient coverage only when an unexpected incident occurs and they have to place a claim with their insurance company.

So, a logical starting point to determine if you have proper insurance coverage is to understand the basics. To ensure that you do have the proper coverage, you first need to acquire a good understanding of the basics of auto, home, personal umbrella, and life insurance coverage. For this article, we will focus on auto insurance coverage.

Auto Insurance basically covers you for liability and property damage as it relates to your motor vehicle. There are other optional areas of coverage as well, but for our discussion let’s stay focused on the basics, which are the most important anyway. Your auto insurance policy’s first and/or second pages are the declaration pages of your auto insurance policy. The declarations pages describe your auto coverage limits in numeric dollar values.

Here is a sample of what you may see on your auto insurance policy’s declaration pages:

-Bodily Injury/Property (BIPD) 250/500/100
-Limited or Unlimited
-Medical (Med) $5,000
-Personal Injury Protection (PIP) 250 w/250 Ded
-Uninsured/Underinsured (UM/UIM) 250/500/100
-Collision $500 (Coll) Deductible
-Comprehensive (Comp) $500 Deductible
-Rental Insurance (RI) 80%/1500

Let’s take a look at each of these coverage definitions and amounts in more detail.

The BIPD represents Bodily Injury (BI) / Property Damage (PD). Basically, in the example above, this individual policyholder has liability protection for $250,000 per individual or $500,000 maximum per incident, plus $100,000 in property damage to the other party’s vehicle in a collision. Liability coverage is protection for times when you have been deemed and proven negligent in an auto accident and you therefore become legally liable for the resulting compensatory and/or punitive damages to the other party or parties. The BI, of the BIPD, will cover you for negligence on your part that resulted in bodily injury to the other party or parties. BI also covers the cost of attorney fees associated with any litigation brought against you by the other party. In the above example, this person has $250,000 in coverage for all inclusive liability and attorney fees per individual injured or $500,000 for the entire incident.

The PD, of the BIPD, covers the damage to the other party’s vehicle as a result of your negligence; thus, in the above example, up to $100,000 in property damage to the other party’s vehicle or property. Now, being cognizant of the litigious society that we live in, we ask if $250,000 per person or $500,000 per incident is enough BI coverage? This is a personal decision for every individual to make depending upon their current assets and net worth, and their knowledge of recent jury decisions and awards on BI cases. A major factor affecting this decision is an understanding that you are self-insured for any amounts awarded in excess of your BI coverage amount, should the jury award compensatory and punitive damages greater than your BI coverage amount. So, in this example, should the jury award $750,000 to the individual driving the other vehicle who suffered bodily injury because you collided with them as a result of your negligence, then you are self-insured for the amount in excess of $250,000 which in this case would be $500,000. If you do not have the $500,000 to settle the award, then the judge has many other options to ensure restitution to the injured party such as: garnishing your wages, selling off some of your assets, placing a lien on your property, etc. Now, you can get an umbrella policy to cover you up to a certain amount in excess of your underlying auto BI coverage. We will look at how an umbrella policy works in more detail in an upcoming article.

Next, we have “limited right to sue” versus “unlimited right to sue” coverage. Basically, under the “limited” right to sue lawsuit option, you agree not to sue the person who caused the auto accident for your pain and suffering unless you sustain one of the permanent injuries listed below:

-Loss of body part
-Significant disfigurement or scarring
-A displaced fracture
-Loss of a fetus
-Permanent injury
-Death

Please note that choosing this option does not waive your right to sue for economic damages such as medical expenses and lost wages.

Under the “Unlimited” right to sue lawsuit option, you retain the right to sue the person who caused an auto accident for pain and suffering for any injury. Most people will choose the “limited” option because it is far less costly and it provides the ability to sue the negligent party for most major and permanent injuries. However, many attorneys will usually choose the “unlimited option” for their own personal coverage and pay the significant extra cost because they want the right to sue for any injury.

PIP coverage stands for Personal Injury Protection coverage. PIP is paid from your own policy. PIP covers medical expenses, and possibly lost wages and other damages. PIP is sometimes referred to as “no-fault” coverage, because the statutes that enacted it are generally known as no-fault laws. PIP is designed to be paid without regard to “fault,” or more properly, without regard to legal liability. PIP is also called “no-fault” because, by definition, a claimant’s, or insured’s, insurance premium should not increase due to a PIP claim. A PIP claim may be subrogated by your insurance against the other party’s insurance company if the other party was determined to be the neglligent party in the accident. PIP is a mandatory coverage in some states.

Uninsured/Underinsured (UM/UIM) is coverage from your policy that may pay for injuries to you and your passengers, and possibly damage to your property, when as a result of an auto accident the other driver is both legally responsible for the accident and determined to be “uninsured” or “underinsured.”

An uninsured driver is a person who has no auto insurance coverage, or had insurance that did not meet state-mandated minimum liability requirements, or whose insurance company denied their claim or was not financially able to pay it. In most states, a hit-and-run driver is also considered an uninsured driver as it pertains to paying for injuries to you or your passengers.

An underinsured driver is a person who had insurance that met minimum legal requirements, but did not have high enough coverage limits to pay for the damage caused by the accident. In these situations, UIM coverage can pay you for your damages. It is important to note that uninsured and underinsured is separate coverage, although in many states they can or must be purchased together. Some states mandate purchase of UM/UIM, but many do not.

Collision coverage insures you for damage to your vehicle. No matter if it is a collision between your car and another car, or your car and a stone wall. You are covered if your car sustains damage as a result of colliding into something or something colliding into it, whether you are at fault or not. Your deductible will usually apply. If you collide with another vehicle and the other party is at fault, then your insurance company may subrogate the claim against the at fault party’s insurance company to recover the claim amount.

Comprehensive (Comp) basically covers what collision coverage does not. When your car sustains damage that did not result from colliding with another motor vehicle or object, the comprehensive portion of your policy will pay for the damages. If you do not have comprehensive coverage then you would have to pay out of your own pocket for any damage to your vehicle not related to a collision. Here are the perils typically covered by comprehensive auto insurance coverage: fire, theft, vandalism, broken or damaged glass, animal inflicted damage, falling objects, storms (hail, wind, etc.), and water damage. Your deductible will usually apply.

Rental Insurance (RI) is coverage for you to rent a car while your vehicle is being repaired because of a covered incident. In the above example of declaration page values, the 80%/1500 means that you have coverage for $80 per day and $1,500 maximum total cost to rent a car while your vehicle is being repaired. This is an optional coverage that many people take, but some do not.

Well, that is it! That is the basics of understanding your auto insurance coverage. Not so bad, right? Now that you understand the basics of auto insurance coverage you can review and analyze your personal auto insurance policy’s declaration page coverage information while taking into consideration your personal financials to determine whether or not you have sufficient coverage.

Stay tuned for future articles that will explain the basics of understanding homeowner’s, personal umbrella, and life insurance coverage. You never know when it is going to rain!

Joseph Rubino, Agent
NJ Licensed Property & Casualty, Health, and Life