New Jersey Infertility Health Insurance

New Jersey Infertility & IVF Health Insurance

New Jersey Infertility Health Insurance Laws

New Jersey Infertility and IVF health insurance in mandated by state law.

The New Jersey Family Building Act is an insurance law that requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility.  Before jumping into any infertility treatments know that the law does not apply to every NJ resident, and the law has limitations.  What you will find on this page:

  • Who is covered?
  • What infertility treatments are covered?
  • Where are the holes?

New JerseyNew JerseyNJ Maternity Leave laws are some of the richest in the country. New Jersey allows up to 18 weeks of partially paid, job protected leave for normal pregnancy, and longer if complications arise. Benefits are limited and don't apply to everyone. Understand how NJ Temporary Disability, Paid Family Leave, and Family Medical Leave laws work with federal rules.

Bed Rest Disability

Getting 2/3 of my pay from NJ Temporary Disability seemed like a good deal until my fertility doctor told me to stop working 12 weeks before delivery.  I then delivered early with multiples which required me to stay at home longer than expected.  Without a second short term disability policy I don't know what we would have done.
Patrick & Michelle C.

NJ Infertility Insurance - What is Covered?

The New Jersey Family Building Act requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility including:

NJ Infertility Insurance - Who is Covered?

The NJ Infertility Insurance law covers employers with more than 50 employees. So if you work for a larger employer headquartered in New Jersey, chances are you will be covered.  Confirm coverage with your employer before beginning infertility treatments.

The New Jersey Infertility Insurance rules have many exceptions once you take a closer look.

The law can only be enforced when the NJ State Insurance Department has jurisdiction to regulate.  If your employer is headquartered in another state, your employer is not subject to this mandate.

The law regulates health insurance companies, 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.

Employers with less than 50 employees are not subject to this law. 

New Jersey Short Term Disability: Pregnancy, Maternity LeaveNew Jersey Short Term Disability: Pregnancy, Maternity LeaveNew Jersey Short Term Disability Insurance can add to your maternity leave pay, while protecting your family in case of pregnancy/delivery complications, accidents and illnesses.

NJ Infertility Insurance Madate - Where are the Holes

The NJ Family Building Act 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.

Cut your infertility treatment costs by 1/3 or more by using your flexible spending account to pay for un-reimbursed infertility treatment expenses.

Get interest free fertility treatment financing through your flexible spending account.  Your annual election is available on the first day of your plan year for eligible expenses such as your IVF procedure, and other infertility treatments.

Filling Holes in NJ Infertility Coverage

You may find that your employer does offer health insurance with infertility coverage.  And even if they do, 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.

Supplemental PoliciesSupplemental PoliciesSupplemental maternity policies fill important holes for growing families.  Mom may need to miss time from work before delivery, and may be in and out of the hospital if she experiences a high-risk pregnancy.  If your infant(s) require a NICU stay there may be extra bills to pay.  Couples undergoing infertility treatment may find an added bonus for multiples!
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