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New York Infertility Mandate
New York Infertility & IVF Insurance Mandate
New York infertility health insurance coverage is mandated by state law. NY IVF insurance coverage is not. You must cover your own IVF costs, or apply for a grant that helps fund this expensive procedure.
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. Infertility coverage is one of three main considerations for a growing family:
- Finding insurance that pays fertility treatments, fertility drugs, etc
- Benefits for your resulting pregnancy and hospitalization
- Income replacement during your maternity leave and in case of complications
Supplemental Maternity Insurance Don't start another infertility treatment without investigating what happens to pregnant women in New York when they leave work for maternity leave, or prior to delivery because of pregnancy complications. $170 per week is a miserly wage replacement level. Even with an mandate in place for infertility coverage you may be faced with many unpaid bills. Don't forget about replacing more of mom's income.
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NY Infertility Mandate: What Procedures are Covered?
New York's Infertility Health Insurance laws require private insurance plans to cover medically necessary expenses incurred in diagnosis and treatment of a correctable medical condition even if it results in infertility. Coverage is included if the procedure corrects the underlying medical condition.
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 law specifically excludes certain infertility treatment procedures including:
- In Vitro Fertilization (IVF)
- Gamete Intrafallopian Transfer (GIFT)
- Zygote Intrafallopian Transfer (ZIFT)
- Reversal of elective sterilization:
- Cloning
- Sex change procedures
- Experimental treatments
- endometrial biopsy
- hysterosalpingogram
- hysteroscopy
- laparoscopy
- sonohysterogram
- post coital tests
- testis biopsy
- semen analysis
- blood tests and ultrasound
NY Infertility Law - Who is Covered?
The New York infertility law applies to group, and blanket accident and health plans. Blanket accident and health plans are designed to protect individuals while using certain services: common carrier services, employees while working, students on a college campus, etc.
Group health insurance plans make up to core of who the law applies to. Group health plans insure more than one individual. Exceptions are unions, self-insured employers, and programs regulated by the federal government.
The union exception might be quite large. Teachers often belong to unions, and may purchase health insurance through union. If so many teachers may not be subject to the mandate.
Large employers tend to self insure, and New York is the headquarter state of some of the nation’s largest employers. The more employees, the more economical it may be to self insure. There may be quite a few NY workers whose health plan is not subject to this mandate.
Finally, health insurance is regulated primarily at the state level. If your employer is headquartered outside of New York State, then your plan will not be subject to this law. Your plan will need to comply with any infertility law in the headquarter state - if there is one. Only fifteen states have a mandate, so the odds are low.
IVF in New York State: Grants and Funding Options
New York's mandate does not address every single expense you may encounter. A variety of popular procedures are not covered. The most notable of these is In Vitro Fertilization (IVF). Expenses can run very high and pile up very quickly. Here are five approaches to make getting pregnant via IVF more affordable:
The provides grants and subsidies for qualifying couples seeking IVF,GIFT, and TESE treatments from participating infertility providers.
IVF is tax deductible. Your unreimbursed expenses for IVF and any other qualified expenditure can save you money on your taxes. Both Schedule A deductions, and a Flexible Spending Account (FSA) provide some savings, but have various advantages and limitations you should research.
Get an IVF loan from your employer. Using your FSA allows you to get an interest free loan with 52 weeks to repay using pre tax dollars.
Leverage hidden advantages of IVF refund programs. Many couples miss a big tax savings opportunity and a chance to bet an informed bet based upon your clinics history of treating patients with your specific medical conditions.
Take advantage of supplemental insurance to cover the biggest exposure of IVF: multiple embryos implanted to increase odds of conception. Multiple embroys often mean twins, triplets, or more. Multiple pregnancies are often high risk, and are delivered pre-term. There may be long periods of bed rest with no income from mom, followed by left over hospital bills associated with a lenghty NICU stay for your infants. Make sure you get protected before your next IVF cycle.
Sources: NY Infertility Law, Definition of Blanket Accident Plan, Definition of Group Health Plan, New York Infertility Demonstration Program
