New York State is now one of thirteen states in the United States to cover IVF treatment. As of January 1, 2020 New York residents enjoyed expansion of In Vitro Fertilization (IVF) and Fertility Preservation coverage. New York Insurance Law §§ 3221(k)(6)(C) and 4303(s)(3) now mandates that “large group” insurance policies and contracts which provide medical, major medical, or similar comprehensive-type coverage, and are delivered or issued for delivery in New York, will cover three cycles of IVF used in the treatment of infertility. They are defining a “large group” as a group of more than 100 employees.
Any insured person who is seeking IVF coverage must be diagnosed with infertility. Infertility is defined as a patient that has tried to conceive for at least 12 months with unprotected intercourse, or in the case of patients using donor sperm, 12 cycles of therapeutic donor insemination. In the case of women over the age of 35, the definition of infertility is limited to 6 months of unprotected intercourse or 6 cycles of artificial insemination with donor sperm.
A formal diagnosis of infertility requires an evaluation with a reproductive endocrinologist and infertility specialist. Diagnostic tests include ovarian reserve testing, analysis of sperm quality and quantity, blood work to evaluate overall health and an evaluation of female reproductive anatomy. These tests can be completed quickly and easily within a few weeks. After these diagnostic tests are completed, patients meet with their clinical team to determine what treatment options are recommended.
As per the NY State Mandate, an IVF “cycle” is defined as any treatment cycle that is initiated with medications to stimulate oocyte production with the end goal of an oocyte retrieval, and plan for a fresh embryo transfer. An IVF “cycle” is also defined as any cycle where medications are initiated for endometrial preparation with the intent of undergoing a frozen embryo transfer. There are no longer any age limits for any covered infertility services.
There are some limitations to this new law. Self-insured employers and small groups ( <100 employees) are not required to provide this coverage. Also, for persons who have undergone voluntary sterilization procedures (i.e. tubal ligation or vasectomy) issuers are not required to cover procedures to reverse a previous voluntary sterilization procedure or infertility treatment for a person in connection with such reversal. Also, GIFT, ZIFT, sex change procedures or experimental medical or surgical procedures are not covered.
A wonderful addition to this law is coverage for fertility preservation for any patient who might be at risk for “iatrogenic sterility”. This is defined as “an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes”. The collection, freezing, preserving, and storing of ova or sperm and other standard services that are not experimental or investigational are to be covered under this new law.
I would encourage any New York patient who is interested in finding out more about these benefits to make an appointment with an IRMS doctor for a consultation. You can reach us at 718.697.0255 or by filling out our contact form and reaching us through our social handles
Click here, for further information about the NY State IVF and Fertility Preservation Law and please reach out to your employer to learn more about your benefits coverage
Melissa C. Yih, MD, is Board Certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing in the NJ area since 2002. Dr. Yih received her undergraduate degree from Wellesley College and her medical degree from The Robert Larner, M.D. College of Medicine at The University of Vermont. She completed her Obstetrics and Gynecology residency and her clinical fellowship in Reproductive Endocrinology and Infertility at New York-Presbyterian Weill Medical College of Cornell University. Her areas of interest include counseling patients regarding fertility preservation options.