Skip to main content

Our Doctors Respond to Roe v. Wade News

Affording Treatment

New York State Infertility Mandate

What is the New York State Infertility Mandate?

Effective January 1, 2020, the state of New York requires all large group insurance providers to cover up to three cycles of IVF for people with a medical diagnosis of infertility. The mandate also requires insurance plans to cover egg and sperm freezing for medically necessary purposes, including, but not limited to, sickle cell anemia, cancer diagnosis and surgery for endometriosis.

Plans that include coverage for prescription drugs must include coverage of drugs approved by Food and Drug Administration (FDA) for use in the diagnosis and treatment of infertility. You may be able to purchase an insurance rider that will pay for some or all fertility treatment expenses not covered in your plan, whether it is self-funded or not.

Schedule Your Consult Learn More
FTC_image2_circle
New York State Mandate

Exclusions & Limitations

Unfortunately, due to the current definition of infertility (which is 12 months of unprotected sex without achieving a pregnancy), the New York State mandate does not cover same-sex male couples. Visit Gay Parents To Be for resources and support for LGBTQ+ families.

Additionally, the mandate leaves out providers in fully-insured small group plans (companies with less than 100 employees), employers with self-insured plans, Obamacare and Medicaid. People enrolled in so-called “self-insured” group health insurance plans (primarily used by large corporations and unions) are governed by federal law, so the New York State mandate does not apply to them.

Ask your employer’s HR or benefits team if your employer is fully-insured or self-insured. If your employer is self-insured, they can choose to cover IVF and fertility preservation.

two dads

Get your Financial Planning for Fertility Treatment eBook

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!

 

HAVE MORE QUESTIONS?

Illume Fertility can help.

Our team of eight board-certified reproductive endocrinologists and comprehensive support staff are ready to help you create the family of your dreams. Take the first step by scheduling your consult today to learn how Illume Fertility can help you achieve your goals.

Schedule Your Consult Learn More
IllumeDocs_GroupPhoto_edited (1)