Ill. Admin. Code tit. 50, § 2015.43 - Donor Expenses
a) The
medical expenses of a donor for procedures utilized to retrieve oocytes or
sperm, and the subsequent procedure used to transfer the oocytes or sperm to
the covered recipient or to the surrogate shall be covered. Associated donor
medical expenses, including but not limited to physical examination, laboratory
screening, psychological screening, and prescription drugs, shall also be
covered if established as prerequisites to donation by the insurer.
b) No group accident and health policy or
health maintenance organization group contract that provides coverage as
required by this Part shall exclude coverage for a known donor. In the event
the insured or member does not have arrangements with a known donor, the health
plan may require the use of a contracted facility. If the insured or member
uses a known donor, the health plan may require the use of contracted providers
by the donor for all medical treatment including, but not limited to, testing,
prescription drug therapy and ART procedures, if benefits are contingent upon
the use of such contracted providers.
c) If an oocyte donor is used, then the
completed oocyte retrieval performed on the donor shall count against the
insured or member as one completed oocyte retrieval under Section
2015.35(b).
Notes
Added at 28 Ill. Reg. 12992, effective September 9, 2004
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