New Jersey Infertility Mandate
New Jersey Infertility & IVF Health Insurance
New Jersey Infertility and IVF health insurance is mandated by state law.
The New Jersey Family Building Act is a state insurance law that requires health service corporations, hospital service corporations, health maintenance organizations, medical service corporations, and health insurance companies to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility.
Who is Covered by the NJ Infertility Mandate
The NJ Family Building Act applies to policies delivered, issued, executed or renewed in New Jersey for groups of 50 or more persons that provide hospital or medical benefits, including pregnancy-related benefits. That is a mouthful that needs to be pulled apart to better understand, plus there are other notable exceptions.
New Jersey Definition of Infertility
The New Jersey law has a precise definition of infertility. Infertility is defined as a disease of the reproductive system that results in an abnormal function so that:
What Infertility Procedures are Covered?
The NJ Family Building Act requires that infertility coverage is provided to the same extent as any pregnancy related procedure. The plan may not impose a separate copayment, deductible, or coinsurance, except limiting egg retrievals to four for the lifetime of each covered person. The carrier may not impose a separate of substantially different preauthorization requirement for any infertility treatment.
Infertility Treatments Exempt from NJ Mandate
Certain procedures are specifically excluded from the mandate. Reversal of voluntary sterilization is not covered: vasectomy reversal, and tubal ligation reversal. Partners of anyone who underwent a successful sterilization reversal may not be excluded. All other persons undergoing a sterilization reversal will need to pay these costs out of pocket.
Medical payments for a surrogate during any ensuing pregnancy are not covered, unless the surrogate is a member of the same plan. The costs of cryopreservation, sperm, embryo, egg storage, non medical costs, experimental treatments, ovulation and sperm testing kits are not included in the mandate. IVF, GIFT, and ZIFT procedures are not covered until all reasonable and less expensive options have been used. Any person over the age of 46 is not covered.
Source: NJ Benefit Standards for Infertility Coverage