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New York Infertility Insurance Mandate

New York is one of just 15 states that has an infertility insurance mandate in place. An infertility insurance mandate is a law that requires insurers to offer coverage or to provide coverage for fertility treatment costs or in vitro fertilization (IVF) costs. New York law on fertility treatment insurance coverage is found in the New York Consolidated Laws, Insurance, Sections 3221 and 4303.

New York infertility insurance law was enacted in 1990. According to the New York fertility treatment insurance law, insurers must provide coverage for the diagnosis and treatment of medical conditions that result in infertility. This law applies to private, group health insurance plans that are issued by the state of New York that provide hospital, medical, or surgical care.

New York fertility treatment insurance law states that “infertility” will be determined in accordance to the guidelines established by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.

The fertility treatment insurance law clarifies that the following fertility diagnostic tests and fertility treatment procedures must be covered: hysterosalpingogram, hysteroscopy, endometrial biopsy, laparoscopy, sono-hysterogram, post coital tests, testis biopsy, semen analysis, blood tests and ultrasounds. Any health insurance policy that provides coverage for prescription drugs must also include coverage for fertility medications that are approved by the Food and Drug Administration (FDA) for the diagnosis and treatment of infertility.

New York Infertility Insurance Mandate Limitations

Like most of the states that have laws in place to cover fertility treatment costs, New York law does include some stipulations for coverage. Most noticeably, IVF costs are not covered under New York law. Additionally, insurance plans are not required to cover the following:

  • Assisted reproduction procedures including in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) , or zygote intra fallopian transfer (ZIFT)
  • The reversal of elective sterilization procedures (tubal ligation or vasectomy)
  • Sex change procedures
  • Cloning
  • Experimental medical or surgical procedures for fertility treatment

New York law on fertility treatment coverage specifies that coverage will be provided for patients only between the ages of 21 and 44. In order to be eligible for coverage, individuals must also have been covered under the policy for at least 12 months.

Comments (18)

Hi I'm 35 yrs and I had laparoscopy surgery done, the doctor say the safest way for me to conceive is by IVF. I'm asking would insurance cover the procedure and which insurance is best to used

Hi there,

Some of the major providers like Aetna, Blue Cross Blue Shield, and United Healthcare may cover fertility treatment. You should call the companies directly to find out what is covered and what is not.

Best,
Kim

I have New York fedelis and I want to do the IUI WILL they cover it ??

Hi Jones,

You will have to contact your insurance provider directly to find out what is covered under you policy.

Best,
Kim

My daughter in law has both Medicare and Medicaid. She is diabetic and is vlose to getting a kidney transplant. If her egg and my sons sperm were implanted in a donor would that procedure get covered?

I have Oxford health insurance. My husband is being tested for infertility and my doctor wants to give me fertility shots but I have not been tested yet. Will they be covered? Do I have to get tested first and if I am infertile will it then be covered? I'm so confused and my insurance company advised that they need to put in a claim to see if it's covered. But I don't want to put a claim in then get denied. Please help! Thank you!

Please contact your insurance provider directly to ask them what tests, medications and treatment they cover. Good luck!

Hi , How can I do infertility insurance????? I have fidelis care is my insurance cover it ???

Please contact your insurance provider and ask them what tests and treatment they cover. Best, Claire

My husband and I have been married for 4 years and have been ttc for 2 years with no luck. Would you happen to know if HIP covers fertility treatments. I live in NY

I am a 40 year old woman and I want to have a baby with a donor sperm (IVF). I have Medicaid (Fidelis Care). Does my insurance cover it?

I'm sorry, but Medicaid does not cover IVF. Best, Claire

I'm 23 and my husband is 31 we been married for hree years ... He has a low sperm count and has been put on medication and also had a precedure done but nothing helped ... I have health plus insurance and live in NYC .... Please tell me what insurance will pay for ivf

Different insurance plans will provide different coverage, and not all infertility doctors accept all insurance plans. If you have insurance coverage, you should call you plan administrator and ask them about coverage. And if you are looking for a doctor who accepts you insurance we can help. Call our patient care advocates at 855-955-2229 or email us at carecoordinator@fertilityauthority.com. Best, Claire

Paying $10000 for second ivf and it is about $4000 in meds and my ins denied me coverage claiming its cause of infertility I thought the mandate claims that ins policies have to cover the meds Please help !

Hi Tricia - There are some exceptions to the NY insurance mandate, including individually purchased policies, Medicaid and some group health insurance plans which comply with Federal, not State laws. You should call the administrator of your policy to determine why you don't have coverage for fertility drugs. Best, Claire

do you accept insurance for ivf? do you need to be married? I'm 36 and he is 55, i don't have a problem getting pregnant he has a very low sperm count. How can you help

Hi Pam, We can definitely help you connect with a New York fertility clinic that accepts health insurance (we would need to know the name of your insurance plan). You do not have to be married, though the female partner's insurance is what the clinic bills to. Give us a call at 1-855-955-BABY (2229) or email carecoordinator@fertilityauthority.com and we will gladly assist you further. Best, Kim

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