By Kara Cerrone, Director of Channel Partnerships
Big news has arrived in New York to the world of fertility coverage, and we think you need to know about it! A new state mandate makes New York 1 of 17 states spearheading coverage for fertility and family planning services across the nation.
So, what’s the mandate?
Starting January 1, 2020, 5 million New Yorkers will have coverage for (in)fertility services like IVF and egg freezing through their insurance coverage, completely changing the continuum of care as we know it.
After years of advocacy to modify the existing NYS Mandate from 2002 (yes 17 years ago!), the bill was signed in April 2019. We’d say it’s about time, as 1 in 6 couples struggle to conceive naturally, and an increasing number of single parents and same-sex couples require these services as well.
So what does this mean? And how do you know if you qualify for coverage?
First, what coverage is mandated?
- 3 IVF cycles
- Egg freezing for patients where fertility could be impaired by radiation, medication or surgery, or other medical intervention (i.e. cancer patients, endometriosis, gender reassignment)
Who does the mandate apply to?
Before we can answer that, you’ll need to understand if your employer is “self-insured,” which means they fund and manage their own health insurance, or if they are “fully-insured,” which means insurance is funded and managed by an insurance company.
For IVF coverage: The mandate stipulates that all fully-insured plans for employers with over 100 employees must provide coverage for 3 cycles under the new law. The employee must meet the newly-defined definition of infertility for treatment: an inability to conceive after regular, unprotected sexual intercourse or donor insemination for 12 months if you are under 35 or 6 months if you are over 35.
Because donor insemination is included in this new definition, any single mothers or same sex female couples who have been trying intrauterine insemination (IUI) without success would also be eligible for coverage.
For medically-necessary egg freezing (fertility preservation): all fully-insured plans regardless of employer size must provide coverage if infertility may be caused by a medical intervention like certain medications, radiation or surgery (ex: cancer patients, endometriosis, gender reassignment surgery).
At Kindbody, we are on a mission to improve accessibility of fertility services. There is still more work to be done for same sex male couples and surrogacy laws, but we are so proud of our home state for taking this very important step!
By the way, did you know Kindbody works directly with employers to offer fertility benefits, including for egg freezing? Reach out to firstname.lastname@example.org to learn more!