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Changes to New York Insurance Law in 2020 – Am I Covered?

In March of 2019, the New York State legislature passed a new budget for 2020 which includes an important update to an existing insurance law. This law takes effect on January 1, 2020 and may allow over 2 million New Yorkers to qualify for IVF or fertility preservation coverage.

What does the updated insurance law do?

  1. The new law provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to people who get their health insurance from a fully-insured employer with over 100 employees who provides qualifying coverage.
  2. It also provides medically necessary fertility preservation treatments for people facing iatrogenic infertility (infertility caused by a medical intervention).
  3. The law prohibits the delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.

Who is entitled to coverage under the new law?

  • Straight couples who need IVF
  • Lesbian couples who need IVF (depending on your insurance carrier, you may be required to undergo qualifying procedures)
  • Single women who need IVF (depending on your insurance carrier, you may be required to undergo qualifying procedures)
  • People who need to freeze their sperm or eggs for medically necessary reasons (qualifying procedures and conditions include chemotherapy for cancer, gender affirmation surgery, sickle cell anemia, bone marrow transplant, surgery for endometriosis).

What kind of insurance do I need?

If you get your insurance from a New York-based employer that has over 100 employees and a fully insured, Large Group plan and meet the criteria outlined above, you likely qualify for IVF or medically necessary fertility preservation coverage.

Individuals who need medically necessary fertility preservation treatments and get their insurance from the individual market may also qualify for coverage.

Who is NOT covered?

  • People on Medicaid
  • People who receive their health insurance from the Exchange in New York (Obamacare)
  • Employees of small companies (fewer than 100 employees)
  • Employees of companies that self-insure (companies with over 1,000 employees usually fall into this category)
  • People with health insurance provided by the Federal government
  • Veterans
  • Gay male couples may have difficulty obtaining coverage due to the definition of “infertility” as outlined in the law

What if my employer is self-insured?

If your employer is self-insured, they can opt to cover IVF and fertility preservation. Here are some resources to help you request coverage from your employer: https://resolve.org/what-are-my-options/insurance-coverage/coverage-at-work/getting-insurance-coverage-at-work/

What’s the next step?

We recommend that you start by reaching out to your employer’s benefits department to determine if you are eligible for fertility treatment or fertility preservation coverage under this new law. During your health insurance open enrollment, make sure you take the time to understand the IVF coverage under the different options offered by your employer or your partner/spouse’s employer. 

If after speaking with your employer you have any questions about how this coverage pertains to your current or future care at RMA Long Island IVF, our financial counselors will be happy to assist you. To receive a preliminary list of employers that may provide qualifying coverage, click here.

Sources:

New law in New York means most insurance plans will now cover IVF
#ACCESS2CARE Win in New York