New Guidelines for Women's Healthcare Announced in CT

Gov. Malloy and Conn. Insurance Department Announce New Guidelines to Expand Health Care for Women

New Guidance Expands Access to Care to Prevent Infertility

Governor Dannel P. Malloy and Connecticut Insurance Department Commissioner Katharine L. Wade today announced that new department health insurance guidance will increase access to infertility treatment for women 40 and older.

"We are providing health insurance like never before - we are indeed a national model for how to get residents great access to care and coverage.  As a result, the Affordable Care Act is changing lives," Governor Malloy said.  "This announcement reflects our efforts to ensure that women have the coverage they need."

An Insurance Department review of the age limit of 40 that was set in state statute in 2005 has determined that infertility treatment may be clinically effective for individuals older than 40.  Individuals receiving infertility treatments, an essential health benefit in Connecticut under the Affordable Care Act (ACA), must be healthy and the treatment must be medically necessary to be covered.  Male infertility treatment is also covered under the mandate.

The ACA prohibits discrimination in benefit design.  As such, the new standards take effect on policies issued or renewed on or after January 1, 2016.  The guidelines are specified in Bulletin HC-104, which was issued August 13, to repeal and replace the 2005 guidance in Bulletin HC-64.

"This new guidance requires private health insurers to remove the age limit of 40 as a condition of coverage for infertility treatments when medically necessary," Commissioner Wade said.  "Limits to coverage that are discriminatory run counter to the clear intent of the Affordable Care Act and we must ensure that our state laws and guidelines are compliant."

Commissioner Wade said the department worked with Connecticut's health insurers to revise and refine the guidelines.  The agency also consulted with the National Women's Law Center.

"More people in Connecticut have health insurance than ever before and we must continue to make certain that their access to Connecticut essential health benefits is unimpeded," she explained.  "Clarity is essential when implementing a law as vast and unprecedented as the Affordable Care Act."


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