New York State IVF Coverage: What You Need to Know About the 2020 Fertility Mandate
2020 is starting off with great news (think fireworks!) for the 1 in 8 New York couples who need fertility treatment to build a family. This celebration is specifically for those who need in-vitro fertilization (IVF) and fertility preservation coverage. Thanks to a bill passed last year in New York and having taken effect on January 1, 2020, residents of the state went from no IVF coverage to three cycles covered by insurance!
We celebrate as New York state becomes the 10th state in the United States to specifically cover IVF and the 6th state to cover fertility preservation. (There are 16 states that cover some sort of fertility coverage, but not IVF.)
Curious about the history, IVF facts, what’s new, and what to expect from this bill? Everything you need to know about the new 2020 mandate is below.
And check out this short video by RESOLVE that also covers the basics.
History of Fertility Treatment Coverage in NY
In the early 1990s, the first fertility insurance law in New York was written, specifically excluding IVF. This was considered a win at the time; it was helpful to those who needed and could be successful with intrauterine inseminations (IUIs) and other forms of fertility treatment.
There was an update to the original bill in 2002, but even with newer research and information on the efficacy of IVF, it was still excluded.
Given that IVF is now the “gold” standard of fertility treatment, yielding much higher pregnancy rates, denial of insurance coverage has meant that people in New York state have either endured financial hardship or been unable to afford, due to lack of insurance coverage, to successfully build their families.
Regardless of financial burden and insurance neglect, IVF has continued to boast impressive statistics.
Recent IVF Statistics
- Statistics in 2016 report that there were 263,577 IVF cycles done in the United States. It’s safe to assume it’s a higher number now, 4 years later.
- In that same year, there were 81,022 pregnancies and 65,996 deliveries derived from IVF.
- Total infants born from IVF in 2016 were 76,930 (55,244 single babies, 21,686 multiple birth babies)
- There are 42 fertility practices in New York State that report to the Center for Disease Control (CDC). IVF success rates vary widely, depending on fertility diagnosis, age of intended parents, and experience of fertility practice.
So it’s clear that IVF helps people build their families. Finally, the new and improved New York State Mandate acknowledges those numbers and changed the policy to include IVF coverage. This is life changing for many New York state residents.
The New Mandate Offers a New Definition of Infertility
Up until now, infertility has been defined as the inability to become pregnant, with regular “exposure” to sperm, in a one year time period for people 35 years of age and under (and 6 months for those older that 35).
But here’s the new definition, according to the 2020 New York State Fertility Mandate:
‘Infertility’ means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.”
The new definition opens the door for a much more inclusive understanding of a complex set of reproductive health problems that all reside under the umbrella of infertility. It particularly opens the door for lesbians or single moms to be, as it addresses therapeutic donor insemination.
Despite the specific lack of mention for gay men, the language in this new insurance mandate is non-discriminatory based on gender or sexual identity, therefore also covering gay men. This is a major win, as there are few if any other states with that type of coverage.
What Else is New with the New York State Mandate?
Here, we break it down for you point-by-point:
- 3 IVF cycles (lifetime) to policy holders of fully insured employers who are a Large Group market (over 100 employees).
- Fertility medications are included! This is a piece of this legislation that is not being talked about but can mean the difference between affordable care and unaffordable care.
- Freezing and storing of gametes are also included when the coverage applies.
- It’s fully non-discriminatory and covers all people, regardless of age, sex, sexual orientation, marital status, or gender identity.
- Fertility preservation is a big win on this bill. It will cover persons whose fertility might or will be impacted by medical intervention, giving them an opportunity to freeze gametes or whatever is medically necessary. This will be true for all commercial markets, as well as fully insured Small and Large Group markets. The New York State frequently asked questions sections answers, “Q-7. What fertility preservation services are required to be covered? Standard fertility preservation services include the collecting, preserving, and storage of ova or sperm.”
- New York Infertility Demonstration Program will be left intact and may provide assistance to those not covered by the new bill.
When Does it Take Effect?
Immediately! This bill went into effect January 1, 2020.
How Much Coverage is Offered?
In addition to the fertility coverage that has previously been offered in New York state, 3 rounds of IVF treatment will now be available, when determined to be medically necessary by the fertility doctor. And unlike some of the other 16 states that offer fertility treatment coverage, there is no clause in this bill that determines a prerequisite of other fertility treatment cycles offered first. Meaning, it doesn’t make you try other methods of fertility treatment before you can try IVF. Simply put, if IVF is needed, IVF is now able to be used.
Thank you Governor Cuomo, RESOLVE: The National Infertility Association, American Society for Reproductive Medicine, the Alliance for Fertility Preservation , EMD Serono, Ferring Pharmaceuticals, and so many more who worked on getting this bill passed.
Special thanks to Risa Levine, Esq.
And thank you to Governor Cuomo and his staff for putting together a list of frequently asked questions, answered in an understandable way!
But Wait! There’s More! Gestational Surrogacy and Second Parent Adoption
In the spirit of fertility coverage, there is more very exciting news to talk about!
In 2019, there was a piece of legislation lifting the gestational surrogacy ban in New York that, despite a lot of support and effort, didn’t pass. What is surprising is how quickly it’s being reintroduced in 2020, showing that it’s on the top of Governor Cuomo’s to-do list.
One legitimate question to ask is “Why is it so important?” One slightly embarrassing answer is that New York state is only one of three states that doesn’t “permit” gestational surrogacy, that in fact prohibits compensated surrogacy contracts (Louisiana and Michigan being the other two). This is a position that Governor Cuomo would like to see changed. He has a lot of company in this—Assemblywoman Amy Paulin (co-sponsor of the bill), State Senator Brad Hoylman, Family Equality Council, RESOLVE, ASRM, and Gay Parents To Be would like to see rectified. (Thank you to New York Assemblywoman Aravella Simotas and New York State Senator Diane Savino for first introducing Fair Access to Fertility Treatment Act.)
Details of the Proposed Bill:
- Lift the ban on gestational surrogacy
- Include a Surrogates’ Bill of Rights
- Create legal protections for parents of children conceived by ART (assisted reproductive technology)
- Establish criteria for surrogacy contracts
- Simplify process for second parent adoption
Gestational surrogacy addresses one important component of how infertility can exhibit itself, a uterine dysfunction (or with a gay male couple, there is no uterus). This bill will put New York state in the company of 47 other states, that allow compensation to be paid to the gestational surrogate. It will also ease the process for second parent adoption.
IVF Coverage in New York State is Finally Here
2020 is the launch of a new decade. And for New York state residents, it means IVF coverage, for those who have Large Group coverage (over 100 people). It will mean more affordable family building, less financial hardship, and the knowledge that appropriate medical treatment is available for those with infertility. This is maybe our biggest reason to celebrate a Happy New Year!
Wonder what the IVF process is like?
Hear about it straight from a fertility nurse.
About Lisa Rosenthal
Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.
Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.
Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.
Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.