As of January 1, 2019, a new law goes into effect requiring that fertility preservation be covered by Illinois health insurance companies for patients diagnosed with cancer or who experience iatrogenic infertility, also known as medically-induced infertility.
For the first time, Illinois patients will not have to choose between effective medical treatment and a future chance at a family. This change is a long time coming, and Illinois is the fifth state in the country to adopt this into law.
According to the Illinois Department of Public Health, a reported 5,800 Illinois residents of reproductive age – between age 14 and 45 – are diagnosed with cancer each year. The majority of cancer patients are at risk for medically-induced infertility as a result of their cancer treatment. Patients undergoing treatment for sickle cell anemia, lupus and other autoimmune diseases may also experience medically-induced infertility.
We’d like to explain what this new law includes, what is covered, who is eligible, and how you can access these new benefits.
What is covered: Standard fertility preservation services including the preservation of eggs, embryos and sperm for patients with cancer and certain other diseases.
Who is eligible: Those with IL-based health insurance who are at risk of experiencing medically-induced infertility as a result of treatment for cancer, sickle cell anemia, lupus, and other autoimmune diseases. Medically-induced infertility is defined as impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes. Treatment may directly or indirectly cause infertility, meaning that there is a likely possibility that treatment will cause a side effect of infertility based upon current evidence-based standards.
The law also states that an insurer shall not discriminate based on an individual’s expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, or marital status.
Who isn’t covered: Keep in mind that this law offers very broad coverage, but not all will be eligible. Unfortunately, Illinois patients with health insurance that is not based in Illinois are not eligible. Health insurance that is regulated and overseen by the federal government also does not adhere to state law. This includes federal employees, those with an ERISA (Employee Retirement Income Security Act of 1974) plan, TRICARE for the military, and Medicaid.
For patients who are ineligible, Fertility Centers of Illinois offers discounted fertility preservation treatment. The Livestrong Fertility Program also offers discounted treatment and medication to accepted applicants, and the Heart Beat Program from Ferring offers free medication to women with cancer.
Determining eligibility: The best way to determine your coverage is to reach out to your HR department as well as your insurance company.
Keep in mind that coverage will vary – outside of this law, you may have coverage. For example, some companies such as Facebook and Google cover fertility preservation. Veterans Administration is not covered under this law but they have created their own plan that covers fertility preservation. Companies with ERISA plans may have opted for this benefit in their own plan.
Appointment requests: We see cancer patients within 24-48 hours of appointment request to discuss the fertility preservation process and begin treatment as soon as possible. The best candidates for freezing eggs or embryos are pre-menopausal women who have clearance from their oncologists to use injectable fertility medications and undergo the procedure.
The treatment process:
- Egg Freezing: The entire egg freezing process requires roughly three weeks to complete. A woman is placed on medication that stimulates the ovaries to create eggs, and is monitored via ultrasound regularly. Once egg development is optimal, a 15-minute egg retrieval procedure is completed and the result eggs are frozen.
- Sperm Freezing: A male provides a sperm sample which is then frozen for future use. Samples can be produced at home or in a dedicated private room at our offices.
- Embryo Freezing: Once eggs are retrieved, they are injected with sperm in our laboratory. The resulting embryos are cryopreserved for future use.
Working with your Oncologist: We work closely with your oncologist to ensure that we do things in a way that continues to make it safe for the patient to pursue fertility preservation without affecting cancer treatment. It is important to note that long-term studies have shown no decrease in the number of patients who survive if they have gone through fertility preservation. Patients who are unsure on whether to pursue treatment can set their minds at ease regarding this concern.
Choosing a center: It is overwhelming to receive a cancer diagnosis and navigate cancer treatment and preserving your fertility at the same time. When choosing a center to work with, select one that has extensive egg and embryo freezing experience and women who have returned to use their eggs or embryos and then had children. When there is truly one opportunity to preserve fertility, it is essential to work with an experienced team.
As you work with your insurance provider and respective medical teams, please reference and share the links below for background information on this new law.
Veterans Health Administration: VHA Directive 1332 Infertility Evaluation and Treatment – VA.gov