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.
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.
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