Insurance and IVF – NY State Now Requires Coverage
Assisted Reproductive Technology (ART) includes many techniques with varying success rates to treat infertility. One such technique, IVF (In Vitro Fertilization), has been at the forefront of the news since the birth of the world’s first IVF baby, Louise Brown, in the United Kingdom in 1978. Although cost has declined over the years, related expenses still pose an economic barrier for many potential parents. Treatment for infertility is not one of the ten essential benefits. Consequently, coverage for IVF is not mandated by the Affordable Care Act (Obamacare) or any other federal law. It is left to the individual states to mandate coverage. Less than 20 states require coverage (see link in ‘Learn More – Primary Sources’ for the current list). As of 2020, New York State now joins that list. IVF will be covered for up to 3 cycles (applies to large group plans that provide coverage to 100 employees or more). The coverage requirement for medically necessary egg freezing (e.g., radiation therapy) would apply to large, small and individual insurance providers. The new law states (New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 3216(i)(13), Section 4303(s))
Every group policy issued or delivered in this state which provides coverage for hospital care shall not exclude coverage for hospital care for diagnosis and treatment of correctable medical conditions otherwise covered by the policy solely because the medical condition results in infertility
…in no case shall such coverage exclude diagnostic tests and procedures provided as part of such hospital care that are necessary to determine infertility or that are necessary in connection with any surgical or medical treatments or prescription drug coverage provided pursuant to this paragraph, including such diagnostic tests and procedures as hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital tests, testis biopsy, semen analysis, blood tests and ultrasound; and provided, further however, every such policy which provides coverage for prescription drugs shall include, within such coverage, coverage for prescription drugs approved by the federal Food and Drug Administration for use in the diagnosis and treatment of infertility
The determination of “infertility” in accordance with the standards and guidelines established and adopted by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine
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