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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
- 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.