New York Infertility & IVF Health Insurance Coverage

New York infertility health insurance coverage is mandated by state law. NY IVF insurance coverage is not.  You must cover your own IVF costs. 

Before undergoing any infertility treatments be sure to understand what the law does and does not cover, who the mandates applies to, and find alternatives to cut costs and create security for your pregnancy and maternity leave.

But the law has limitations, and not all residents and workers are covered.  Discover what is covered, who the law applies to, and how to cut costs for infertility and IVF treatments.  Infertility coverage is one of three main considerations for a growing family:

1. Coverage that pays fertility treatments, fertility drugs, etc
   
2. Benefits for your resulting pregnancy and hospitalization
   
3. Income replacement during your maternity leave and in case of complications
   

Be sure to consider all three.

New York's Infertility Health Insurance laws requires private insurance plans to cover medically necessary expenses incurred in diagnosis and treatment of infertility. Coverage is limited to individuals between the ages of 21 to 44 who have been covered under the same policy for at least 12 months. Health insurance plans that include coverage for prescription drugs must also cover fertility drugs approved by the FDA.

The NY Infertility Laws specifically excludes certain infertility treatment procedures including:

• In Vitro Fertilization (IVF)
  
• Gamete Intrafallopian Transfer (GIFT)
  
• Zygote Intrafallopian Transfer (ZIFT)
  
• Reversal of elective sterilization:
  
• tubal ligation reversal
• vasectomy reversal
• Cloning
  
• Sex change procedures
  
• Experimental treatments
  

The New York Infertility Insurance mandate has many exceptions once you take a closer look. 

The law can only be enforced when the NY State Insurance Department has jurisdiction to regulate.  If your employer is headquartered in another state, your employer is not subject to this mandate, but may follow the applicable state infertility mandate - if there is one.

The law regulates health insurance plans, not employers.  If you work for a large employer that self insures, you may not be covered.  Check with your HR department before undergoing infertility treatments.

The current infertility mandate does not cover policies written after September 2002.  Any newly written insurance plan does not need to comply.  

The NYS Infertility Insurance law requires that certain infertility treatments be covered, but it does not stipulate the level of coverage.  Every insurance plan leaves you with some level of unreimbursed expenses.  Things like co-pays, co-insurance, and out of network charges can add up very quickly.  For example:

• Some prescription drug plans provide 50% reimbursement.  The other 50% of your fertility drug costs are yours.
• Co-insurance, the amount of allowed charges that are your responsibility may run to 20% to 30%.
• Out of network fees may come into play if your fertility clinic of choice is not in network with your plan.  You will be responsible for the amounts over and above what the insurance company reimburses as usual customary and reasonable.

New York infertility insurance does not cover every single expense you may encounter.  You may find that your employer does offer health insurance with infertility coverage.  And even if you find converage in the individual market, you may find that you still have many left over bills.

Be sure to take full advantage of our cost saving opportunities, and fund your maternity leave by purchasing supplemental health insurance before getting pregnant. 

The NY Infertility Insurance law prohibits the exclusion of coverage for the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.   This makes New York state unique.  Most other state mandates apply only to employer groups of 50 or more. 

This means you can find health insurance in the individual market that covers infertility.