CCRM FERTILITY CLINICS IN NEW YORK
Understanding New York Infertility Insurance Requirements
New York State has some of the most comprehensive fertility insurance protections in the U.S. Many patients benefit from mandated coverage for diagnostic testing, medically necessary fertility preservation, IUI, and sometimes IVF treatment, depending on their employer group size.
Mandated Coverage for Diagnostic Testing
Under NY Insurance Law Sections 3216 and 3221, state-regulated group health plans must cover a wide range of diagnostic services used to evaluate infertility, including:
- Hysterosalpingogram (HSG)
- Hysteroscopy
- Endometrial biopsy
- Laparoscopy
- Sonohysterography (SIS/sono-hysterogram)
- Post-coital testing
- Testicular biopsy
- Semen analysis
- Blood tests
- Ultrasound
These diagnostic procedures cannot be excluded simply because infertility is involved.
Definition of Infertility Under New York Law
New York defines infertility as:
- 12 months of regular, unprotected intercourse or therapeutic donor insemination, OR
- 6 months for individuals 35 or older
Coverage may apply earlier if medical history or clinical findings suggest testing or treatment is medically necessary.
IVF Coverage Requirements in New York
New York mandates IVF coverage only for large-group insurance plans (employers with 100+ employees). These plans must cover:
- Up to 3 IVF cycles (fresh or frozen embryo transfer)
Important notes:
- Individual and small-group plans are not required to cover IVF
- Employers that self-insure are exempt from state mandates and may offer different infertility benefits
Mandated Coverage for Medically Necessary Fertility Preservation
All commercial insurance markets in New York—including individual, small group, and large group plans—must cover fertility preservation for iatrogenic infertility, including:
- Chemotherapy or radiation
- Surgeries impacting reproductive function
- Medications or treatments that may cause infertility
Standard fertility preservation procedures are covered, even though they are not specifically defined in the statute.
Non-Discrimination Protections
New York prohibits insurance discrimination based on:
- Age
- Sex or gender identity
- Sexual orientation
- Marital status
This ensures inclusive access to fertility testing and treatment for individuals and families using donor sperm, donor eggs, gestational carriers, or nontraditional paths to parenthood.
Important Exceptions
New York insurance law does not require coverage for:
- IVF in individual or small-group plans
- GIFT or ZIFT
- Reversal of elective sterilization
- Experimental procedures
- Some gender-affirming procedures when categorized separately by an employer’s plan
Any treatment under a self-insured employer, unless voluntarily covered
New York locations
CCRM Fertility of New York
810 7th Ave., 21st Floor
New York, NY 10019
Phone: (212) 290-8100
Fax: (212) 239-6500
CCRM Fertility | IRMS – Staten Island
1441 South Ave., Suite 201
Staten Island, ny 10311
Phone: (718) 697-0255
Fax: (718) 521-6151