AFFORDING TREATMENT

New York State Infertility Mandate

Last updated: October 3, 2025. Coverage varies by plan and may change.

the basics

About the New York State Infertility Mandate

New York requires basic infertility coverage across individual, small-group, and large-group plans when you meet the medical definition of infertility.

In addition, large-group fully insured policies (more than 100 employees) must cover up to 3 IVF cycles, including the medications that are part of each cycle.

Note: Self-funded (ERISA) employer plans and government programs follow different rules, so the details of your individual policy still matter. After your initial consult at Illume Fertility, a Financial Coordinator will help you confirm your eligibility.

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at a glance

New York State Infertility Mandate

Learn what the New York infertility mandate typically covers:

Covered Services

Individual, small-group, and large-group fully insured plans must cover basic infertility care when you meet the definition of infertility, including diagnosis and treatment of correctable causes and basic treatments such as intrauterine insemination (IUI). IVF is required only on large-group plans.

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Cycle Limits

Large-group fully insured plans must cover up to 3 cycles of in vitro fertilization (IVF) over the insured patient's lifetime, with no annual dollar caps or age caps permitted on this IVF benefit. Preauthorization may apply and standard cost-sharing can be used by the plan (see Cycle Definition).

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Cycle Definition

One IVF cycle refers to one full attempt. This includes morning monitoring visits, blood work and ultrasounds, medications needed for that cycle, the egg retrieval with anesthesia, the lab work to fertilize and grow embryos, and either a fresh or frozen embryo transfer (FET) with uterus preparation.

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Preservation Coverage

All market sizes must cover standard fertility preservation when medical treatment may cause infertility, including collection, freezing, and storage of eggs or sperm. Age-based restrictions are not permitted; plans may require medical necessity review and preauthorization as allowed.

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Network Rules

HMO and EPO policies may limit infertility, IVF, and preservation benefits to in-network providers under the plan’s terms. PPO and POS policies must mirror any out-of-network benefit they offer for these services, with applicable preauthorization and cost-sharing.

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Who Must Comply

These state requirements apply to fully insured New York policies; self-funded ERISA plans and programs like Medicaid managed care, the Essential Plan, and Medicare are not subject to the mandate. We encourage you to confirm your plan type with your employer or plan sponsor during enrollment.

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the impact

What does this mean for me?

After your initial fertility consultation, your assigned Financial Coordinator will confirm whether your plan is fully insured and in network for Illume Fertility, check any prior authorizations, and prepare a transparent cost estimate.

Throughout your journey, our team is happy to answer questions, help you locate additional resources, and recommend financial assistance or financing programs if needed.

Tip: Keep your insurance card, plan benefits summary, and any referrals in a virtual or physical folder for easy access.

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free resource

Your Guide to Financial Planning for Fertility Treatment

Budgeting for fertility treatment can feel overwhelming - especially when you don't have all the facts. That's why our experts have created a free, helpful resource to help guide you: our Financial Planning for Fertility Treatment eBook.

Learn about financial planning for treatment, how to maximize your insurance coverage, what to ask your insurer to determine your benefits and much more.

Fill out the form to download your free Financial Planning for Fertility Treatment eBook now!

your questions answered

NY Infertility Mandate FAQs

Learn more about how the New York state infertility mandate works:

How do I know if my plan is large-group and fully insured?

Are IVF medications and anesthesia included?

How long is embryo, egg, or sperm storage covered?

Does coverage apply if I am single or LGBTQ+?

dive deeper

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Your New York Fertility Experts

Our team of board-certified reproductive endocrinologists and comprehensive support staff care for New Yorkers at our conveniently located clinic in Westchester County, as well as our nearby Norwalk, Stamford, and other Connecticut locations.

After your initial visit, you’ll be paired with a dedicated Financial Coordinator who will review your benefits under New York’s requirements, verify in-network status for our clinic, and provide a clear, personalized estimate so you know what's ahead.

Schedule your first consult to get started today.

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