Commentary

Reproductive Insurance Coverage

** This blog is for general informational purposes only and is not, nor is it intended to be, legal advice.

The New Year is always an exciting, refreshing time in our personal and professional lives. So far this year we have witnessed great changes in how states (and people) are treating infertility. New York joins a small group of states that have updated their existing infertility statute. Last year New York  lawmakers passed a new statute that requires certain large-group insurance plans to cover up to three cycles of in vitro fertilization (IVF). The new law was proposed in 2019 and went into effect January 1, 2020. This is huge, especially since so many people (approximately ten percent of women in the United States) receive assistance for infertility.

The New York State Department of Financial Services estimates that this new infertility law will positively help an estimated 2.4 million New Yorkers.

So, what is infertility? Infertility is defined as the incapacity to impregnate another person or to conceive after 12 months of regular, unprotected sexual intercourse, or after 6 months of regular, unprotected sexual intercourse for women 35 or older.

Based on the definition of infertility, the fertility provisions of this New York law only cover treatment for single or married heterosexual women. Thus, gay couples, who make up a significant portion of the couples who wish to use assisted reproductive technology in order to grow their family, are potentially excluded. Because the definition of infertility is gender-specific, politicians, lawyers, and hopeful parents are advocating for a change in the definition of infertility.

How do you know what type of plan offers coverage?

Large insurance plans that provide coverage to 100 employees or more must cover in vitro treatments and associated medications and testing for people with infertility. Three cycles of IVF are included. Unfortunately, employees of small and medium-sized companies are not guaranteed coverage through this New York law.

What about egg/sperm freezing?

Certain large-group insurance plans must cover cryogenic egg freezing and sperm freezing but only for medically necessary purposes, such as for individuals undergoing chemotherapy for cancer treatment or sex-reassignment surgery.

Does this plan include surrogacy?

No. Although several bills have been introduced this session to legalize surrogacy, surrogacy is currently illegal in New York State. Additionally, insurers are not mandated to cover the healthcare of a person outside the family unit.

Please note that this blog post does not mention Virginia. Why? Because at the time of this writing, Virginia is not one of the 16 states that offer infertility coverage and treatment. Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia require insurance companies to either cover infertility treatment or require insurance companies to offer coverage for infertility treatment.

Information for this blog post can be found at:

Infertility Coverage by State

New Fertility Coverage in New York State

What’s Covered under New York’s New In-vitro Law?

IVF and Fertility Preservation Law Q&A Guidance