Maryland requires fully insured individual and large-group plans (more than 50 employees) that cover pregnancy to cover outpatient IVF — up to 3 attempts per live birth and a $100,000 lifetime cap — for married opposite-sex, same-sex and unmarried patients who meet a history requirement.
Your plan
What the law does
Fully insured, employers with more than 50 employees
Likely required to cover IVF — 3 egg retrievals, unlimited transfers. Applies when the plan renews on or after 1997-10-01.
Fully insured, smaller employer
Not covered by the law. Any benefit is voluntary plan design.
Individual / marketplace plan
Likely required to cover IVF.
Self-funded employer plan (card says "administered by")
Exempt from state law (ERISA). Coverage, if any, is your employer's choice — check the Summary Plan Description for a fertility rider or lifetime maximum.
Medicaid
Does not cover IVF.
Free, 5 steps, nothing saved unless you choose to.
The one thing to check first: is your plan self-funded?
State fertility laws only reach fully insured plans. Most workers at large employers are in self-funded plans, which are governed by federal ERISA law and exempt from every state mandate — 67% of covered workers nationally, and about 80% at firms with 200+ employees (KFF 2025).
Look at your insurance card. If it says "administered by" (an insurer's name as the third-party administrator), your plan is probably self-funded. If it says "insured by" or "underwritten by," it is probably fully insured. The card is a strong hint, not proof — the only definitive answer comes from HR: "Is our medical plan self-funded or fully insured?"
This also decides where a denied claim goes: fully insured plans appeal to the state insurance regulator; self-funded plans appeal under ERISA rules to the U.S. Department of Labor.
What the law requires
Cycle cap: 3 completed egg retrievals with unlimited embryo transfers — Insurers may limit coverage to 3 IVF 'attempts' per live birth, not to exceed a $100,000 lifetime maximum benefit. The statute does not define 'attempt' as a retrieval; carriers commonly count each stimulation/retrieval cycle as an attempt. After a live birth the 3-attempt count resets but the dollar cap does not..
Dollar cap: plans may limit the benefit to $100,000 lifetime.
Who qualifies: the definition of infertility is inclusive — single people and LGBTQ+ patients qualify without a heteronormative 'unprotected intercourse' requirement.
Step therapy: the law allows plans to require IUI before IVF except: patients with endometriosis, DES exposure, blocked or surgically removed fallopian tubes, or abnormal male factor (medical-condition pathway instead of 1-year history or 3 AI attempts).
Medications: not addressed by the law — plan-specific.
PGT-A genetic testing: not addressed by the law — plan-specific.
Embryo storage: not addressed by the law — plan-specific.
Donor eggs/sperm: not addressed by the law — plan-specific.
Surrogacy: not covered.
Fertility preservation before cancer treatment: required.
Where people get surprised
Small-employer plans (50 or fewer employees) are exempt from the IVF mandate.
Self-funded employer plans are exempt under ERISA — common among large Maryland employers and federal contractors.
The $100,000 lifetime cap is on the benefit paid, and IVF medications and PGT may count against it depending on the plan.
Same-sex and unmarried patients must document 3 IUI/AI attempts in a year before IVF is covered unless a qualifying medical condition applies.
Religious organizations can request an exclusion; storage of frozen sperm/eggs is not covered under the fertility preservation section.
How to appeal a denial
Internal appeal — you have 180 days from the denial to file. The plan must decide within 30 days (before service) or 60 days (after service); 72 hours if urgent.
External review — available for at least 4 months after the final internal denial, for medical-necessity and "experimental" denials (PGT-A, ICSI, step therapy). An independent reviewer decides within 45 days. Contractual exclusions are not eligible for external review — those go to the regulator as a complaint.
Regulator — Maryland Insurance Administration (MIA). MIA Appeals and Grievances Unit — independent review of adverse decisions (medical necessity) under Ins. Title 15, Subtitle 10A File a complaint. Copy the regulator on every appeal letter; clinics report it speeds things up.
If your plan is self-funded, skip the state regulator: your appeal runs under ERISA and complaints go to the U.S. Department of Labor's Employee Benefits Security Administration.
Frequently asked
Is IVF covered by insurance in Maryland?
Maryland requires fully insured individual and large-group plans (more than 50 employees) that cover pregnancy to cover outpatient IVF — up to 3 attempts per live birth and a $100,000 lifetime cap — for married opposite-sex, same-sex and unmarried patients who meet a history requirement.
My employer is large but my card says 'administered by' — does the state law apply?
Probably not. 'Administered by' usually means a self-funded plan, which federal ERISA law exempts from state insurance mandates. Confirm with HR.
The law took effect but my plan doesn't cover IVF yet — why?
The requirement applies to plan years beginning on or after 1997-10-01. If your plan year renews mid-year, coverage starts at that renewal.
What if my claim is denied?
File an internal appeal within 180 days, request the exact policy language relied on, and copy the regulator. Medical-necessity and 'experimental' denials can go to external review.
This page explains public coverage rules and typical prices as of the dates shown. It is an estimate and an interpretation, not a coverage decision by your plan, and not legal, medical, tax, or insurance advice. Your plan documents control. We never store what you enter here unless you choose to save a plan.