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Infertility Insurance Coverage in Southern New Jersey

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One of the most problematic parts of dealing with infertility is understanding the insurance coverage you do or don't have to help pay the costs of infertility treatment. Residents of New Jersey are fortunate to be among the 15 states that have state mandated laws offering some insurance coverage to help cover the costs of fertility diagnosis and treatments. This legislation is known as the Family Building Act.

New Jersey Insurance Coverage for Fertility Treatment

In 2001 New Jersey passed Chapter 236 legislation. It meant health insurance carriers were legally required to offer insurance coverage for medically necessary expenses arising from infertility. Coverage includes but is not limited to medication, surgery, in vitro fertilization (IVF), embryo transfer, artificial insemination, gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection, and 4 completed egg retrievals for a woman in a lifetime of coverage. New Jersey legislation also states group insurers and HMO’s that offer pregnancy insurance coverage must also offer infertility related coverage. This coverage does not include treatments that are defined as “experimental.”

Infertility Insurance Exemptions in New Jersey

New Jersey infertility legislation is similar to other states in that it does have restrictions. These include regulations stating there is an exemption for employers that have less 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. There is coverage only if the woman has not used the maximum number of 4 egg retrievals by age 45. Infertility treatment must be done at programs meeting standards of practice approved by the American Society of Reproductive Medicine (ASRM) or the American College of Obstetricians and Gynecologists. There is a restriction that insurance companies are not mandated to offer fertility insurance benefits to companies with less than 50 employees. Employers who self insure are also exempt from this legislation. Non medical costs for egg or sperm donation are not covered. Finally, religious organizations can request an exemption from coverage if infertility treatment goes against the religious beliefs of the employer.