Question regarding infertility clause in Illinois
Can someone help me understand what is the meaning of the below text? I am struggling to understand whether point 1, 2 and 3 must all be met altogether OR it is enough if one of these points is met.
For example,
A) Will insurance cover the treatment of 35 years old woman who is trying to get pregnant for 3 months and was diagnosed with infertility (e.g. some of the blood tests results are bad)?
OR
B) No matter what is the condition of the woman the insurance won't cover anything unless the woman tries to get pregnant for at least 6 months?
Your input will be highly appreciated.
Here is the text of the policy:
"INFERTILITY TREATMENT
Benefits will be provided the same as your benefits for any other condition for Covered Services rendered in connection with the diagnosis and/or treatment of Infertility, including, but not limited to, in-vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer, low tubal ovum transfer and intracytoplasmic sperm injection.
Infertility means a disease, condition, or status characterized by;
1. The inability to conceive a child or to carry a pregnancy to live birth after one year of regular unprotected sexual intercourse for a woman 35 years of age or younger, or after 6 months for a woman over 35 years of age (conceiving but having a miscarriage does not restart the 12 month or 6-month term for determining Infertility);
2. A person’s inability to reproduce either as a single individual or with a partner without medical intervention; or
3. A licensed Physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing."
submitted by /u/James-B7507
[comments]
