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Affording Treatment

New York State Infertility Mandate

new-york-state-infertility-mandate1The State of New York passed a bill that went into effect on September 1, 2002, requiring that private group health insurance plans issued or delivered in the state that provide coverage for hospital care or surgical and medical care must cover the diagnosis and treatment of infertility for patients between the ages of 21 and 44 who have been covered under the policy for at least 12 months.

Several expensive procedures, including in vitro fertilization and vasectomy reversal, are explicitly excluded under the New York State mandate.

Additionally, plans that include coverage for prescription drugs must include coverage of drugs approved by Food and Drug Administration (FDA) for use in diagnosis and treatment of infertility.

The law does not apply to New Yorkers on Medicaid or to people who buy individual policies. People enrolled in so-called “self-insured” group health insurance plans (primarily used by large corporations and unions) are governed by federal law, so the New York State mandate does not apply to them.

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