About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems. Infertility affects many people and is often a misunderstood condition. While there are a number of alternative methods of reproduction, these alternatives can be very costly. One of the most frequently used fertility treatments is in vitro fertilization (IVF).
Many people experiencing fertility issues turn to IVF because of its high success rate, but the process can be a difficult experience emotionally, physically, and financially. A recent New York State mandate is aiming to provide some assistance in the process by requiring certain large group insurance plans to cover IVF starting January 1, 2020. As an employer, it’s important that you know how and if this law will affect your employees.
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What is In Vitro Fertilization (IVF)?
IVF falls under the larger umbrella of assisted reproductive technology and is described as a complex series of procedures used to help with fertility and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from the ovaries, fertilized by sperm in a lab, and the fertilized eggs are transferred to a uterus. The success rate of IVF births are 41% when the mother is 35 and under. The success rate is enticing to a lot of people hoping to reproduce but the cost can be discouraging. The average cost for one round of IVF is $12,000, but this can vary depending on what technologies are being used. This price gets much higher if additional technology is needed to aide in the process.
The New York State IVF Law
The law that’s been enacted in the 2020 New York State budget mandates that large group insurance plans cover IVF. This mandate requires private insurance companies in New York State to cover fertility treatment costs or IVF costs, making New York one of just 15 states that has an infertility insurance mandate in place. This is a big step that is projected to benefit millions of people seeking alternative options to starting a family.
The law goes into effect on January 1, 2020 and requires the following:
Insurance carriers must cover up to three IVF cycles for employees covered under a fully-insured, employer-sponsored large group market policy.
Insurance carriers are only required to cover medically necessary fertility preservation treatments (egg freezing and storage) for people facing iatrogenic infertility (infertility caused by medical intervention, such as radiation, medication, surgery, or other medical treatment). Fertility preservation for infertility caused by medical intervention is required in all commercial markets including the individual market, as well as the fully-insured small group and large group markets.
Prohibits discriminating based on age, sex, sexual orientation, marital status, or gender identity in providing coverage.
What Does This Mean for my Company?
As an employer, it’s important that you check where your health insurance plan is written. If your policies are issued in New York State, even though your company is located elsewhere, you may be subject to the requirements of this new law.
The mandated coverage for IVF is estimated to include 2.4 million New Yorkers, according to Governor Cuomo’s administration. Ten other states currently have mandated IVF coverage, but most have limits on funding, number of cycles, age restriction, and other restrictions. In addition to these ten states, a number of other states require some sort of coverage of fertility treatment.
Large group insurance plans, providing coverage to 100 employees or more, must cover in vitro treatments. Employees of small and medium-sized companies and not on a large group plan (e.g. a plan accessed through a PEO), companies that self-insure, and those with individual insurance plans are not guaranteed coverage.
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.