As of January 1, 2020 New York expanded its in vitro fertilization (IVF) and fertility preservation coverage. New York’s Insurance Law §§ 3221(k)(6)(C) and 4303(s)(3) now mandates that “large group” insurance policies and contracts which provide medical, major medical, or similar comprehensive-type coverage, and are delivered or issued for delivery in New York, will cover three cycles of IVF used in the treatment of infertility. They are defining a “large group” as a group of more than 100 employees.
Anyone seeking IVF coverage must be diagnosed with infertility.
The law defines “infertility” as:
- Any patient that has tried to conceive for at least 12 months with unprotected intercourse.
- Or in the case of patients using donor sperm: 12 cycles of therapeutic donor insemination.
- For women over the age of 35, the definition is limited to 6 months of unprotected intercourse or 6 cycles of artificial insemination with donor sperm.
Which IVF services are covered?
- The law covers three cycles of IVF, including all treatment that starts when preparatory medications are administered for ovarian stimulation for oocyte retrieval with the intent of undergoing IVF using a fresh embryo transfer or medications are administered for endometrial preparation with the intent of undergoing IVF using a frozen embryo transfer.
- Medications, including prescription drugs, are covered under the IVF benefit.
- Egg and /or embryo storage required in an IVF procedure, if medically necessary, until the three required IVF cycles are provided.
- Egg retrieval, creating and freezing embryos when part of an insured patients IVF plan.
- Any patient at risk for iatrogenic sterility is also covered. Latrogenic means an impairment of fertility by surgery, radiation, chemotherapy, or another medical treatment (including gender affirming care) that will affect one’s reproductive organs or processes. Collecting, freezing, preserving eggs or sperm would be covered as long as they aren’t experimental or investigational in nature.
- Elective egg freezing to preserve your fertility for future use is not included.
- The law does not cover fertility services / IVF treatment for those reversing voluntary sterilization procedures like a vasectomy or tubal ligation.
For anyone struggling with infertility or in need of preserving their fertility due to upcoming medical treatment – we urge you to talk to your insurers, your primary care team or your REI’s whether you are covered by New York’s IVF law.
If you reside in New Jersey, you are covered by New Jersey’s mandate.
Any questions or like to book a consult? Our team of fertility experts can help you with your diagnosis and are available for in-person or telemedicine appointments. We also have financial counselors that can help you navigate your options for affording care.
