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Infertility Insurance Coverage in Northern New Jersey

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One of the most challenging aspects of coping with infertility is understanding the insurance coverage available to help cover the costs of infertility treatment. Infertility treatment costs thousands of dollars and repeated cycles are often needed to achieve pregnancy. Residents of New Jersey are fortunate to be among the 15 states that have state mandated legislation offering some insurance coverage to help cover the costs of fertility diagnosis and treatments. In New Jersey, this is called the Family Building Act.

New Jersey Insurance Coverage for Fertility Treatment

In 2001 Chapter 236 legislation was passed in New Jersey. It says health insurance carriers are required to offer insurance coverage for medically-necessary expenses arising from infertility. Coverage includes but is not limited to:

  • Medication;
  • Surgery;
  • In vitro fertilization;
  • Embryo transfer;
  • Artificial insemination;
  • Gamete intrafallopian transfer (GIFT);
  • Zygote intrafallopian transfer (ZIFT;
  • Intracytoplasmic sperm injection; and
  • Four completed egg retrievals for a woman in a lifetime of coverage.

New Jersey legislation also says that group insurers and HMO’s that offer pregnancy insurance coverage must also offer infertility-related coverage. This coverage does not include treatments that are considered “experimental.”

Infertility Insurance Exemptions in New Jersey

New Jersey, like other states, does have restrictions on its infertility legislation. These include:

  • There is an exemption for employers that have fewer than 50 employees.
  • Coverage for IVF, GIFT, and ZIFT is mandated if the patient has used all other reasonable less expensive and medically necessary treatments without getting pregnant.
  • Coverage is available only if the woman has not used the maximum number of four egg retrievals by age 45.
  • Infertility treatment must be done at programs meeting standards of excellence approved by the American Society of Reproductive Medicine (ASRM) or the American
  • College of Obstetricians and Gynecologists (ACOG).
  • There is a restriction that insurance companies are not mandated to offer fertility insurance benefits to companies with fewer than 50 employees.
  • Employers who self insure are also exempt from this law.
  • Non medical costs for egg or sperm donation are not covered.
  • Religious organizations can request an exemption from coverage if infertility treatment goes against the religious beliefs of the employer.