New York law means most insurance plans will now cover IVF

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The price tag for fertility treatments like in vitro fertilization (IVF) are eye-popping. According to the Center for Human Reproduction, the average cost for one cycle of IVF in the United States is about $23,000. But a new law that goes into effect January 1, 2020 could help relieve the financial burden for an estimated 2.4 million New Yorkers.

In April, Albany lawmakers passed a budget measure which updates the state’s existing infertility statute to require all health plans cover up to three cycles of IVF.

Approximately half of New Yorkers with health insurance would qualify for the benefit, according to the New York State Department of Financial Services (DFS). Richard Vaughn, Esq., founding partner of the International Fertility Law Group and former chair of the American Bar Association’s assisted reproduction technology committee, breaks down the new law.

What is the definition of “infertility”?

The state of New York defines infertility as a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined by a physician or by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse, or after six months of regular, unprotected sexual intercourse for women 35 or older.

What does the new law say about reproductive insurance coverage?

Large insurance plans (providing coverage to 100 employees or more) must cover in vitro treatments and associated medications and testing for people with infertility. The law will cover up to three cycles of IVF. The new mandate also requires all insurance plans cover egg and sperm freezing for medically necessary purposes. For example, women undergoing chemotherapy for cancer are often offered the opportunity to freeze their eggs, but decline once they learn the cost, according to a DFS report. Other qualifying procedures include sex-reassignment surgery, sickle cell anemia, bone marrow transplant or surgery for endometriosis.

Single women and gay couples are covered under the plan, but for male couples, it will be difficult to get coverage.

Due to the definition of infertility — ‘12 months of unprotected sex’ — the fertility portion may not work well for gay couples.

Who isn’t eligible under this new law?

Anyone on Medicaid, employees of small and medium-sized companies of less than 100 employees, companies that self-insure and those with individual insurance plans.

Is there any recourse for those people who aren’t covered under the plan?

Unfortunately not. The language concerning definition [of infertility] is by nature biased and needs work. Many of the fertility mandates around the US are gender- specific and thereby exclude coverage for the LGBT community. And LGBT intended parents are a significant patient population in assisted reproductive technology, so this is an area for continued advocacy.

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