Insurance Coverage for IVF in New York - Boston IVF Central New York

Insurance Coverage for IVF in New York

Back in April, the NY State Legislature & Governor Cuomo passed a law to expand insurance coverage for IVF treatment.

It’s wonderful news for New Yorkers who wish to start a family!

WHEN DOES THE LAW GO INTO EFFECT?
The law takes effect on January 1, 2020, on a rolling basis as insurance policies are renewed (although many renew effective January 1st).

DOES MY INSURANCE COVER INFERTILITY AND IVF?
New York requires all Large Group insurance providers (providing coverage to 100+ employees) to cover up to 3 cycles of IVF for people with a medical diagnosis of infertility.

WHO ISN’T ELIGIBLE UNDER THE NEW LAW?
While we ultimately hoped that all New York residents would receive coverage as needed, certain limitations do exist. The mandate leaves out anyone on Medicaid, employees of small and medium-sized companies of less than 100 employees, companies that self-insure and those with individual insurance plans.

ARE SINGLE WOMEN COVERED BY THE LAW?
Yes, if diagnosed with infertility.

IS THE LGBTQ COMMUNITY COVERED BY THIS LAW?
Lesbians are covered, if diagnosed with infertility. However, surrogacy is currently illegal in New York, so single, gay men would not benefit from the new mandate. It’s unfortunate news that will require continued advocacy.

WHAT IS THE DEFINITION OF INFERTILITY?
New York defines infertility as a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined by a physician or by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse, or after 6 months for women 35 or older.

IS EGG OR SPERM FREEZING COVERED FOR INDIVIDUALS WITH CANCER?
Yes! The mandate requires insurance plans in the Large Group, Small Group and Individual markets to cover egg and sperm freezing for medically necessary purposes, including, but not limited to sickle cell anemia, cancer diagnosis, and surgery for endometriosis.

ARE MEDICATIONS COVERED?
Plans that include coverage for prescription drugs must include coverage of drugs approved by the FDA for use in 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.

ANY ADVICE TO LEARN MORE?
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. If you are not sure if your plan covers IVF, contact our team and we will help you determine the level of coverage you have.

SPECIAL THANKS!
Boston IVF would like to thank RESOLVE: The National Infertility Association for all their work organizing countless Advocacy Days, meeting with legislators and administration officials, and advocating for the Fair Access to Fertility Treatment Act, the bill that was passed into law in New York.

ADDITIONAL LINKS