Ill. Admin. Code tit. 50, § 2015.35 - Benefit Limitation/Oocyte Retrieval Limitation

Current through Register Vol. 46, No. 15, April 8, 2022

a) For treatments that include oocyte retrievals, coverage for such treatments shall be required only if the covered individual has been unable to attain or sustain a successful pregnancy through reasonable, less costly medically appropriate infertility treatments. This requirement shall be waived in the event that the covered individual or partner has a medical condition that renders such treatment useless.
b) For treatments that include oocyte retrievals, coverage for such treatments is not required if the covered individual has already undergone four completed oocyte retrievals, except that if a live birth follows a completed oocyte retrieval, then coverage shall be required for a maximum of two additional completed oocyte retrievals. Such coverage applies to the covered individual per lifetime of that individual, for treatment of infertility, regardless of the source of payment.
1) Following the final completed oocyte retrieval for which coverage is available, coverage for one subsequent procedure used to transfer the oocytes or sperm to the covered recipient shall be provided.
2) The maximum number of completed oocyte retrievals that shall be eligible for coverage is six.
c) When the maximum number of completed oocyte retrievals has been achieved, except as provided by subsection (b)(1) above, infertility benefits required under this Part shall be exhausted.

Notes

Ill. Admin. Code tit. 50, § 2015.35

Added at 28 Ill. Reg. 12992, effective September 9, 2004

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