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The 2020 New York State Budget amended the state’s insurance law to now require certain insurers to cover medically-necessary egg freezing and in-vitro fertilization on policies after January 1, 2020. The law affects insurers writing policies delivered or issued for delivery in New York State. The law does not impose any obligations on employers.

What fertility coverage does New York currently require?

Currently, the state’s insurance law requires insurers to cover medical services for the diagnosis and treatment of infertility due to malformation, disease and dysfunction. This coverage includes basic fertility services, including initial evaluation and laboratory testing, and infertility services, including ovulation induction and artificial insemination.

What additional fertility coverage does New York now require?

The new law mandates that all policies delivered or issued for delivery in New York cover medically necessary fertility preservation, which includes egg freezing and the associated storage costs. The medical necessity may be due to surgery, radiation, chemotherapy or other treatment that affects reproductive organs or processes.

The law also requires all large group policies (plans that cover 100 employees or more) delivered or issued for delivery in New York to cover three cycles of in-vitro fertilization and any associated medications and testing. The law does not require individual, small group, or self-insured plans to provide for this in-vitro coverage.

Coverage for in-vitro fertilization and fertility preservation may be subject to annual deductibles, coinsurance, and copayments, to be deemed appropriate by the New York Superintendent of Insurance.

When does the new law take effect?

The new provisions take effect January 1, 2020 and applies to policies and contracts issued, renewed, and modified after that date. The New York State Insurance Department plans to draft guidelines and standards for insurers to adhere to the new law.

Conclusion

Employers have no actions items but should be aware of the law and communicate the new coverage to interested employees.

Additional Resources:

Fiscal Year 2020 New York State Executive Budget, Health and Mental Hygiene, See Part L

 

The information and materials on this blog are provided for informational purposes only and are not intended to constitute legal or tax advice. Information provided in this blog may not reflect the most current legal developments and may vary by jurisdiction. The content on this blog is for general informational purposes only and does not apply to any particular facts or circumstances. The use of this blog does not in any way establish an attorney-client relationship, nor should any such relationship be implied, and the contents do not constitute legal or tax advice. If you require legal or tax advice, please consult with a licensed attorney or tax professional in your jurisdiction. The contributing authors expressly disclaim all liability to any persons or entities with respect to any action or inaction based on the contents of this blog.

Emerald Law– Emerald is a Client Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Emerald enjoys stand-up comedy, live music and writing non-fiction.