New Jersey IVF Coverage Mandate

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New Jersey IVF Coverage Mandate

In the United States, approximately 15-20% of married couples will experience some degree of infertility, defined as the failure to conceive after one year of unprotected sexual intercourse. This means that 1 in 6 couples will need professional assistance. Traditionally, human infertility has been referred to as the “woman’s problem,” ignoring the male contribution. More recent studies show that in a population of infertile couples, about 40% of infertility cases are due to male factors, 40% are due to female factors, and the other 20% are due to a combination of female and male factors.

A diagnosis of infertility does not mean that becoming pregnant is impossible. Nearly 90% of infertility cases are treatable with medical therapies ranging from drug treatment and surgery to advanced reproductive technologies such as in vitro fertilization (IVF).

To completely evaluate the reproductive potential of a couple, a reproductive specialist must see them together to facilitate treatment. Infertility can be a multi-factor problem, where several conditions when presented alone are not so important, but when added together, could markedly influence the reproductive potential of a couple. Therefore, a systematic, simultaneous basic evaluation should be implemented on both spouses.

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New Jersey mandate for infertility coverage

Currently only 16 states in the U.S., including New Jersey, have laws requiring health insurance companies to provide coverage for infertility treatment. The insurance mandate states that any insurance provider who offers pregnancy-related benefits must also cover infertility treatment and IVF costs. The law also requires health plans contracting to cover state employees and teachers to include the same infertility coverage.

A recent update to the mandate defines infertility as “a disease or condition that results in the abnormal function of the reproductive system.” The new law aligns its requirements with the medical definition of infertility, and allows women with same sex partners and women without partners to qualify for infertility coverage.

If you meet the following criteria and definition of infertility, you may be able to receive health insurance coverage for fertility treatment in the state of New Jersey:

  1. A male who is unable to impregnate a female
  2. A female with a male partner and under 35 years of age who is unable to conceive after 12 months of unprotected sexual intercourse.
  3. A female with a male partner and 35 years of age or over who is unable to conceive after six months of unprotected sexual intercourse.
  4. A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision.
  5. A female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision.
  6. Partners who are unable to conceive as a result of involuntary medical sterility.
  7. A person who is unable to carry a pregnancy to live birth.
  8. A previous determination of infertility pursuant to the law.

The New Jersey infertility insurance mandate (officially known as the New Jersey Family Building Act) will cover the costs of the following treatments for eligible patients at a facility that conforms with ACOG and ASRM guidelines:

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The Reproductive Science Center of New Jersey can help you navigate the fertility treatment process from start to finish. Contact us today for more information about the New Jersey IVF mandate or to schedule an appointment at one of our fertility clinics in Eatontown, Toms River, or Lawrenceville.

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