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Affording Treatment

New York State Infertility Mandate

new-york-state-infertility-mandate1Effective January 1, 2020, New York requires all Large Group insurance providers to cover up to three cycles of IVF for people with a medical diagnosis of infertility. The mandate also requires insurance plans to cover egg and sperm freezing for medically necessary purposes, including, but not limited to sickle cell anemia, cancer diagnosis, and surgery for endometriosis. Due to the current definition of infertility - '12 months of unprotected sex without achieving a pregnancy' - unfortunately, this mandate does not cover same-sex male couples.

Additionally, the mandate leaves out providers in fully-insured Small Group plans (companies with less than 100 employees), employers with self-insured plans, Obamacare, and Medicaid. 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. Ask your employer’s HR or benefits staff if your employer is fully-insured or self-insured. If your employer is self-insured, they can choose to cover IVF and fertility preservation.

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. You may be able to purchase an insurance rider that will pay for some or all fertility treatment expenses not covered in your plan, whether it is self-funded or not.

 


 

Are you trying to conceive or planning for fertility treatment in 2020? Check out our comprehensive reference guide to financing for fertility treatment today. 

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