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New Jersey Infertility Insurance Mandate

New Jersey is one of 15 states that has an infertility insurance mandate in place, which requires insurance plans to offer or to provide coverage for fertility treatment costs or IVF costs. New Jersey law on fertility treatment and IVF insurance coverage can be found under Title 17 of the New Jersey Permanent Statutes.

New Jersey infertility insurance law was signed into effect in 2001. Called the Family Building Act, the New Jersey fertility treatment insurance law states that any insurance policy that covers more than 50 people and provides pregnancy-related benefits must also cover the costs related to infertility diagnosis and fertility treatments. IVF costs are also covered under New Jersey law.

New Jersey fertility treatment insurance law clarifies the definition of infertility. According to the section, infertility refers to the disease or condition that results in the abnormal functioning of the reproductive system, in which a person is unable to impregnate another person, become pregnant by trying to conceive with unprotected sexual intercourse after two years if the woman is younger than 35, or one year of unprotected sexual intercourse if the woman is 35 or older, or carry a pregnancy to produce a live birth.

The infertility insurance mandate requires insurers to cover the costs of the following: fertility tests and diagnostics, fertility medications, fertility surgery, in vitro fertilization (IVF), embryo transfer, artificial insemination, gamete intrafallopian transfer (GIFT) , zygote intra fallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), and four completed egg retrievals per lifetime of the covered person.

New Jersey Infertility Insurance Mandate Limitations

Like many of the states that have infertility insurance mandates in place that require coverage for fertility treatments and IVF costs, New Jersey law contains a number of stipulations for coverage. According to New Jersey law, assisted reproduction procedures like IVF, GIFT, and ZIFT may only be covered if the following conditions are met:

  • The person has used all reasonable, less expensive, and medically appropriate fertility treatments and still has been unable to conceive or carry a pregnancy to term
  • The person has not reached the maximum of four completed egg retrievals
  • The patient is under the age of 45
  • The fertility treatment are performed at fertility clinics or medical centers that conform to the guidelines put in place by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists

Religious organizations are exempt from the requirement to provide coverage for IVF, embryo transfer, artificial insemination, ZIFT, and ICSI, if those fertility treatments go against their religious tenets.

Comments (67)

I currently have United Healthcare Community plan which does not cover any fertility treatments but my boyfriend has Aetna Nap First Health, I would like to know if his insurance would cover any of my treatments if we aren't married? Also he already registered for for infertility treatment with his insurance company.

I'm 29 and recently had my last fallopian tube removed due to a second ectopic pregnancy. I have military insurance through my retired husband. Wold I be able to get coverage for IVF?

We'd love to help direct you to a clinic - or use our directory to find a doctor by you. Many clinics can tell you over the phone what your insurance is likely to cover.

I live in NJ as a work at home remote employee. The Company is based out of the UK and has offices in San Francisco & NY. They have 1000 of policies to cover all states in the US and areas of other countries they have remote employees at. The company itself has over 400 employees but I am the only NJ based employee that they have. I had a tubal ligation about 14 years ago with my 1st marriage. I am not remarried and my husband would like to have a child together. How do I go about selecting the correct policy for open enrollment and will this mandate apply to me since I had a tubal ligation years ago?

Huge company in NJ - Aetna HMO plan. They cover infertility treatment like IUI, but exclude ART. Not a religious company, over 100.000 people working worldwide. How can that be with the NJ mandate?

Hi Mark,

If you work for an employer that headquarters in another state, your health plan does not have to comply. You should check with your plan's administrator to find out what is and what is not covered. There are many loopholes.

Best of luck,

I am working for a company in NJ with 50+ employees, still my insurance is not covering IUI, IVF. Only infertility diagnosis is covered. According to NJ mandate, my insurance (Aetna Open Choice PPO) should provide insurance for fertility treatments. Why is my insurance not covering these?

Hi Madhu,

There are loopholes to exempt companies from offering coverage, like religious affiliation. Have you called your HR department? You might also want to talk to a lawyer.

Good luck!

Since it takes 2 to tango... I am wondering which patient the age limit apply to. I am under 45, hubs is over. I am assuming it refers to the female since most times the invasive procedures (ie expensive ones) are done on the female.

Hi Cathy,

That is correct. The female is always considered the patient regardless of diagnosis. The age limit would then apply to the female. All IUI and IVF procedures are billed to the female's insurance.


For permalink, it is my understanding that individual plans under Obamacare must follow state mandate. Horizon bcbs plans include infertility coverage.

You should consult your insurance directly. Coverage may vary depending on the tier you selected. However, I do believe there are loopholes around the mandate when you have independent/private insurance or Obamacare.

You should consult the insurance company directly, but in general insurances cap benefits for fertility at age 45.

How can they do that if the mandate in NJ is until 46? The issue that I am encountering is that the insurance companies do not provide a detail of fertility benefits until you are insured ( and committed to that policy for 1 year, until next open enrollment). I have spoken to agents and listened brokers at all major and several minor insurance companies (9 total) who cannot say with certainty if there is an age limit. Help!

Kristin, You have until your 46th birthday. So technically the very last day of age 45. Good luck! Kim

Hi, I currently live in NY and have been looking into moving to NJ and opting for individual health plan through a private provider. (I am currently enrolled in an Obamacare plan but switching now that it is open enrollment.) My question is, does the New Jersey mandate include individual plans? Also, is there a need to be with a provider for any certain length of time? My fiance lives in Connecticut so I thought about establishing residency there, since it seems CT also has a mandate, but in CT it appears that the age cut-off is 40 and I'm 42. Any ideas? It's looking like it's gonna be out of pocket for IVF regardless of insurance planor where I live.

Hi there,

It is my understanding that individual policies do not cover fertility treatment regardless of the state mandate.

Best of luck to you!

Since my husband's employer is self insured, they do not cover infertility treatment, procedures, etc. I opted to get individual insurance through Horizon BCBS and was verbally told by my agent that IVF was covered (with pre-approval). A few months later, my hubby and I reach out to Horizon regarding getting pre-approved to begin the process of IVF and they inform me that only IUI is covered. Is anyone aware of an insurance provider in NJ that covers IVF for individuals (i.e. not through a NJ-based company with 50+ employees)?

Hi Beth,

Unfortunately, I don't believe any personal policies that you would purchase for yourself will cover IVF. You could confirm directly with the insurance companies. You might also look into for grants or for research studies (free treatment).


My husband works in NJ and his company is based out of Virginia. The company has three buildings in NJ, all three of those locations do not employ 50 people, but the company as a whole does employ more than 50 people. Would we still qualify for the mandate? Or would his building have to have more than 50 employees? I'm not sure how this works.

Hi Jenna,

It depends on where your policy was written, regardless of where the buildings are located. You should call your insurance provider to see what type of benefits you have for fertility treatment.


I live and work in NJ for a very large corporation. My insurance provides pregnancy coverage, but states that infertility treatment like IVF and all of it's related costs are not covered. How can that be if I live and work in NJ?

Hi Allisoto, Each plan is different in regards to coverage. You should check with your plan's administrator to find out what is and what is not covered. Best of luck, Jenna

Hello, I live in CA but my company is based out of NJ. My insurance is currently BC/BS of NJ. There is a $15,000 lifetime maximum for infertility which I have used up after 2 failed attempts of IUI and 1 round of IVF. Based on your previous answers above it looks like employers are able to impose $$ caps but this conflicts with the laws stated in the Mandate which only allows a cap of 4 maximum completed egg retrievals and not dollar amount. Based on that, shouldn't I be able get 3 additional attempts of IVF? What loopholes are employers using to there to get around this??

Hi Laura,

Here is the link to the New Jersey Family Building Act (S1076) Infertility Diagnosis and Treatment was signed into law by Acting Governor Donald DiFrancesco on August 31, 2001.

To view the law online, visit

My recommendation would be to contact your insurance to review your plan details.

Hi Jenna, Thank for your reply. I have already contacted my insurance and they have reiterated that my plan has a $15k max that I have reached. I have already read the NJ mandate that you provided link to and that is why I am asking. In review of the NJ mandate it's states that NJ carriers are NOT to put $$ amount maximums and they are only to put a cap of 4 retrievals. So can the rules in mandate overrule the $15k maximum? Can I use this info to fight to get coverage above and beyond the maximum my insurance is allowing? Are they able to still put a lifetime maximum even though the mandate clearly says they can not?? Or am I reading it incorrectly? Or is there a loophole that I am missing???

Hi Laura, There is really no way of knowing without seeing your specific insurance plan and coverage details. I have worked in Medical Billing for many years, if you want to email me at with more specific details, I would be happy to try and help you. Again, because there are literally thousands of different plans offered, I have no way to give you a direct answer without knowing your situation.

My husband and I live and work in NJ but my company is less than 50 people. My husband's job is greater than 50 employees but they are different locations thoughout the Northeast and the home base is in Canada. I don't know if there are more than 50 employees in NJ, would this count.?


If your husband's both lives and works in NJ, and the company has over 50 employees they are required to offer infertility coverage. My recommendation is to obtain a copy of the "Benefits Booklet" and carefully review what the plan covers, as well as what it does NOT cover.

If you need any help finding a doctor in your area, please email me at and I would be happy to help.

Best of luck,

I live and work in NJ - the company I work for employs well over 50 associates. I am getting ready to start the IVF process and contacted my insurance company to inquire about my coverage. I was told that my coverage was a "3000.00 lifetime guarantee." What does that mean?

Hi Suzie, Typically, the lifetime maximum insurance benefit is the maximum amount that your insurance company will pay, in regards to fertility treatments, during your lifetime. My recommendation is to obtain a copy of your plans "Benefits Booklet" and review exactly what is covered and what is NOT covered. ALWAYS READ THE FINE PRINT! Best of luck, Jenna

Hello, I currently live in AZ, however, my company is based out of NJ. Would I still have coverage for clinics outside of NJ? Also, does my husband also have to be covered under my NJ plan to have coverage for all of the treatments, or only me? Thanks

Hello Megan, Yes! You will have coverage within AZ area. Since your residential state is AZ and your plan is based out of NJ. You have coverage through both. Also NJ infertility coverage happens to have great benefits, if your plan is under the state mandate. Your husband has to be a dependant on your plan to qualify for coverage. Once is on your plan, then he can utilize benefits. Any further questions please contact me directly at 646-568-5601- Thank you. Bhavi

My question is basically the same as Emily's but my insurance is Aetan Open Access and based out of NJ. They are telling me the same thing- testing is covered but not IVF, etc. How is this possible? Thank you!

Hi Kristen,

Is your insurance through your employer? Does your employer have fewer than 50 employees? Is there any religious affiliation with your company? There could be some loopholes. I would call the insurance company directly and also get a copy of the mandate to show your HR department.

Best of luck,

I have insurance through my husband's company - which is based in Georgia. But we live (and work) in New Jersey - and more than 50 people work at his place of business (per the statute). His insurance says they will only cover treatment and consultations for my infertility/PCOS, no procedures or anything else. Because NJ's state mandate, can we fight to get more coverage?

Hi Emily,

Unfortunately, you have to abide by the rules in the state in which the policy was written rather than the state you live in. In this case, Georgia's infertility coverage applies to you. They do not currently have a mandate.

I certainly hope you do not need IVF, but if you do there are savings programs available. Check out Fertility Authority's multi-cycle savings package, IVFAdvantage:

Best of luck to you!

Hi Liza,
Having Medicaid does not qualify you for services of NJ state mandate. Also this insurance does not cover tubal reversal. Since you have your tubes tied, you would be required to do IVF.
Please feel free to contact our Patient Care Advocates at 855-944-2229
Thank you,

Does medicaid clients qualify? If so how does one inquire? I'm planning on reversal if unsuccessful this would be an option

Hi LIza,

Unfortunately, fertility clinics do not participate with Medicaid and Medicaid will not cover fertility treatment. Tubal ligation reversals are not covered by insurance because the tubal ligation and reversal are both considered elective procedures.


Hi, does the mandate specifically address coverage for lesbian couples? It outlines "unprotected intercourse" but does not specify it to be between a heterosexual couple. I have been denied coverage twice, despite stage III endometriosis, using that language. Any recourse? Thank you!

Hi Stacey, I am wondering if you had any luck getting coverage for fertility procedures? My wife and I just started this process and are finding it hard to believe we are being denied coverage as a same sex couple... Any information would be greatly appreciated! Thank you :)

Unfortunately, other than possibly the consultation, insurance does not typically cover same sex family building efforts. I'm very sorry.

You do have a few options:

- You could do something called "Reciprocal IVF" (here's a link on it: and it would cost around $12,000 - $15,000. This is roughly without medication.

- You could do basic In Vitro Fertilization (IVF) (here's a link on it: This would cost around $12,000 - $15,000 as well.

Again, if you have insurance, it may cover the consult but it will most likely not cover the procedure.

- Artificial Insemination (IUI) is another option to consider and it would bring down the cost considerably to around $500, so that's an option to consider if you’re concerned about finances. For more information on IUI feel free to click this link:

In general, a consult without insurance can cost anywhere from $250 - $500 depending on where you go and what is included in the consult.

If you'd like help finding a doctor in your area, please email

The NJ mandate states that coverage extends through age 45, however my healthcare provider cuts off at age 44. Why would they be allowed to do this?

Hi Lacey,

Unfortunately there are loopholes. I would call the insurance company again to confirm.

Best of luck,


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