23 CAR § 80-103. Coverage

Every applicable policy or certificate must provide benefits for in vitro fertilization procedures when: (1) The patient is the policyholder or the spouse of the policyholder/certificate holder and a covered dependent under that policy or certificate; (2) The patient's oocytes are fertilized with the sperm of the patient's spouse; (3) Either: (A) The patient and the patient's spouse have a history of unexplained infertility of at least two (2) years' duration; or (B) The infertility is associated with one (1) or more of the following medical conditions: (i) Endometriosis; (ii) Exposure in utero to diethylstilbestrol, commonly known as DES; (iii) Blockage of or removal of one (1) or both fallopian tubes (lateral or bilateral salpingectomy) not a result of voluntary sterilization; or (iv) Abnormal male factors contributing to the infertility; (4)(A) The in vitro fertilization procedures are performed at a medical facility licensed or certified by the Department of Health. (B) Those performed at a facility certified by the Department of Health conform to the American College of Obstetricians and Gynecologists' guidelines for in vitro fertilization clinics, or those performed at a facility certified by the Department of Health meet the American Fertility Society's minimal standards for programs of in vitro fertilization; and (5) The patient has been unable to obtain successful pregnancy through any less costly applicable infertility treatment for which coverage is available under the policy.