June 14, 1999
(617) 521-7333

Division Of Insurance Completes Review Of HMO Infertility Benefit Guidelines

(BOSTON, MA) The Massachusetts Division of Insurance (DOI), under its authority to regulate HMO activities, today announced that its review of the management of infertility benefits by Massachusetts HMOs concluded with the result that all of the HMOs' eligibility guidelines are now non-discriminatory and in full compliance with the provisions of Massachusetts' insurance regulations.

The review, begun in December of 1998, sought to resolve inquiries questioning whether some HMOs were using arbitrary cut-off ages at which subscribers might no longer be provided the state-mandated benefit. As a result, the DOI asked all HMOs to submit their eligibility guidelines for review.

"The Division met with medical directors from many of the HMOs to clarify their implementation of the infertility benefit. We wanted to ensure that an individual's medical history was the primary consideration for deciding who could receive this benefit and not arbitrary factors such as an individual's age," said Insurance Commissioner Linda L. Ruthardt. "We identified the HMOs that needed to revise their infertility benefit guidelines to be non-age specific and they have done so."

The DOI will continue to ensure that all eligible Massachusetts residents in insured health benefit plans receive infertility and other mandated benefits required by law. Consumers who believe that their HMO may have considered criteria other than medical history in denying their infertility benefits can contact the Office of the Managed Care Ombudsman at 1-800-436-7757 or the Division of Insurance Consumer Service section at (617) 521-7777 or (413) 785-5526.