Prior to 2020, insurance coverage of IVF and other fertility treatments was rare in New York State, but as of January 1, 2020, new legislation mandated large group insurance plans cover in vitro fertilization, and that all insurers cover medical fertility preservation (oncofertility). Below, we’ll break down some of the most frequently asked questions about this law.
What IVF services are covered?
Under New York State Law, large group insurance plans are required to cover three cycles of IVF, beginning with preparatory medications administered for ovarian stimulation ahead of oocyte retrieval with the intent of undergoing IVF for a fresh embryo transfer, and extending to medications administered to prepare the uterus when undergoing an IVF cycle with a frozen embryo transfer.
Are IVF prescription drugs covered if they are not otherwise included in a prescription drug benefit?
Medications used in an in vitro fertilization cycle may be covered under the IVF benefit. Medication coverage is plan dependent. The law defines an IVF cycle as “all treatment that starts when preparatory medications are administered for ovarian stimulation for oocyte retrieval with the intent of undergoing IVF using a fresh embryo transfer or medications are administered for endometrial preparation with the intent of undergoing IVF using a frozen embryo transfer.
What is a large group insurer?
In New York State, an employer or company with 101 or more employees is considered a large group. The IVF mandate refers to these employer-provided health insurance plans. Employees of small and medium-sized companies, as well as those not on a large group plan (i.e. employees of companies that self-insure) are not covered for IVF care under this mandate. However, New York State mandated coverage for medical fertility preservation (oncofertility) applies to all employers and health plans of all sizes.
What is prior authorization?
This law allows insurance carriers to request prior authorization from your healthcare provider before guaranteeing coverage. This requires doctors and other providers obtain approval for treatments and prescriptions from the patient’s insurance company before treatment can begin.
What if I’m still not covered?
While this law is a step towards ensuring everyone who needs or wants treatment for infertility can access care, unfortunately, it does not cover everyone. Infertility patients who are self-insured or are insured by a “small group” employer, and patients undergoing elective egg freezing are not covered under this law.
NYU Langone Fertility Center is committed to helping you navigate all financial aspects of fertility treatment. We offer comprehensive, state-of-the-art infertility treatment at competitive rates, and our team works together with you to evaluate your payment options, including insurance coverage and/or patient financing programs to cover your care. Visit our Navigating Fertility Financing page to learn more about payment options available at NYU Langone Fertility Center.