The 2020 New York State Budget amended the state’s insurance law to require certain insurers to cover medically-necessary egg freezing and in-vitro fertilization (IVF). The law affects insurers writing policies delivered or issued for delivery in New York State on or after January 1, 2020. The law does not impose any obligations on employers.
What fertility coverage does New York currently require?
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 on or after January 1, 2020, in New York cover medically necessary fertility preservation, which includes egg freezing and the associated storage costs. Medications, including prescription drugs prescribed in connection with IVF services, are also covered under the IVF benefit, even if the group health plan does not otherwise include a prescription drug benefit. 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.
Coverage for in-vitro fertilization and fertility preservation may be subject to annual deductibles, coinsurance, and co-payments, to be deemed appropriate by the New York Superintendent of Insurance. The law does not require individual, small group, or self-insured plans to provide for this in-vitro coverage.
Employers do not have any action items but should be aware of the law and communicate the new coverage to interested employees.
Sequoia Tech Program Clients Only
The law requires coverage for policies delivered or issued for delivery in New York State on or after January 1, 2020, therefore Sequoia Tech policies included these benefits for the January 2020 renewal. Please contact your Sequoia team if you need additional information on the new requirement.
Sequoia-One PEO Clients Only
The law requires coverage for policies delivered or issued for delivery in New York State on or after January 1, 2020, therefore Sequoia One will be offering this benefit to New York based enrollees at upcoming plan renewal in July 2020. Your Sequoia One team will be providing additional information and education on this new requirement at the next open enrollment.
Additional Resources:
Fiscal Year 2020 New York State Executive Budget, Health and Mental Hygiene, See Part L
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