What NYC Employees Need to Know About Fertility Coverage This Open Enrollment Season
Open enrollment season is one of the most consequential moments in a fertility patient's year — and one of the most overlooked. For employees across New York City, understanding the details of your health plan before the enrollment window closes can determine whether in vitro fertilization (IVF) is covered, partially subsidized, or entirely out of pocket.
New York's IVF Mandate and Its Limits
New York State now requires large-group, fully insured health plans — those covering 100 or more employees — to provide coverage for up to three IVF cycles per patient. This is a meaningful protection, but it comes with a significant caveat: self-funded plans are exempt from the mandate. A self-funded plan is one in which your employer, rather than an insurance carrier, bears the financial risk of claims. These plans are governed by federal law under ERISA, which preempts state insurance mandates. Many employees at large corporations are enrolled in self-funded arrangements without realizing it, and their IVF coverage depends entirely on what the employer has chosen to include.
How to Determine What Kind of Plan You Have
The clearest way to identify your plan type is to review your Summary of Benefits and Coverage (SBC), a standardized document your employer or insurer is required to provide. Look for language indicating whether the plan is "fully insured" or whether it notes that it is a "self-funded" or "self-insured" employer plan. You may also call the member services number on your insurance card and ask directly. If your plan is self-funded and lacks fertility coverage, open enrollment is the appropriate time to raise this with your HR or benefits department — some employers have added fertility benefits through specialized platforms such as Progyny or Maven, which offer structured, clinically managed coverage distinct from standard insurance.
A Federal Development Worth Noting
A 2024 regulatory update from the federal government will allow employers, beginning with plan years starting in 2027, to offer fertility coverage as a "limited expected benefit." This expands the menu of options available to employers who wish to provide standalone fertility benefits, including for employees on self-funded plans. While 2027 remains on the horizon, this development signals a broader shift toward fertility coverage as a recognized workplace benefit — and one worth advocating for now, during this enrollment cycle.
If you have questions about how your benefits apply to IVF or other fertility treatments, NYU Langone Fertility Center encourages you to schedule a consultation with our team, who can help you understand your options and navigate next steps with confidence.
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The NYU Langone Fertility Center Blog
At NYU Langone Fertility Center, our first job is to support our patients as they become educated about their reproductive health and fertility treatment options. Our blog connects patients with the most up-to-date information, technologies, and insights into fertility care. From egg freezing to IVF to third-party reproduction options, we explore every facet of assisted reproductive technology and empower patients with the knowledge they need to navigate their family building journeys.