New Jersey Infertility Insurance Mandate

Out of the 50 states in the United States, there are only 15 that have any sort of mandate for infertility insurance coverage.  The mandate in each state is different, so do your research about your state’s laws and whether the mandates apply to your employer.

New Jersey’s Mandate:  Insurance policies that cover more than 50 people and provide pregnancy-related benefits must cover the cost of the diagnosis and treatment of infertility.  The patient will receive coverage for up to four egg retrievals after using all reasonable, less expensive and medically appropriate treatments without being able to get pregnancy or carry a pregnancy.  The law can be found in New Jersey Permanent Statutes: 17B:27-46.1X Group Health Insurance Policies; 17:48A-7W Medical Service Corporations; 17:48-6X Hospital Service Corporations; 17:48E-35.22 Heath Service Coporations; 26:2J-4.23 Health Maintenance Organizations.

Additional Tri-State Mandates

New York: Private, group health insurance plans are required to cover the diagnosis and treatment of correctable medical conditions and cannot exclude coverage of a condition solely because the medical condition results in infertility. They are required to provide coverage for the diagnosis and treatment of infertility for patients between the ages of 21 and 44, who have been covered under the policy for at least 12 months. IVF is excluded from this requirement; however, the fertility medications IVF may be covered if the plan provides prescription drug coverage.  The law can be found in New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 4303(s).

Connecticut: Both individual and group health policies are required to cover medically necessary expenses for the diagnosis and treatment of infertility. The individual must have maintained coverage under the policy for at least a year and must disclose any prior fertility treatments they had under a different insurance carrier. Coverage is limited to two cycles of IVF, with not more than two embryo transfers per cycle. The law can be found at Public Act No.05-196.

Stay tuned as the new healthcare plan unfolds.  We’ll be following up on the impact of the Affordable Care Act on future infertility benefits.