As of January 1st, 2020, New York State put a mandate into effect that will require fully-insured large group (over 100 employees) insurers to cover 3 cycles of IVF per lifetime.
The mandate only applies to plans sitused in New York that renew or begin on 1/1/2020 or after. Given that our plans will renew on 11/1/2020, our plans will reflect the state mandate at that time.
Our Aetna plans (not including California HMO) are sitused (written out of) New York State, making them subject to this mandate. This mandate will not include our Kaiser Permanente or UnitedHealthcare plans.
What the Mandate Covers
3 IVF cycles are required to be covered in every Fully Insured Large Group Plan for members who are diagnosed as infertile.
Cryogenic Freezing and Storage of Eggs/Sperm is covered for a sickness causing Infertility or for members receiving radiation treatments that may render them infertile.
No Lifetime dollar limits are permitted - they can only be limited by the number of attempts (the mandated minimum is 3 cycles).
Coinsurance / Copays may be used for coverage.
Infertility is defined as a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five years of age or older. Earlier evaluation and treatment may be warranted based on an individual's medical history or physical findings.
The first step to using comprehensive Infertility health care services is to enroll with Aetna’s National Infertility Unit (NIU). To enroll, members can reach Aetna’s dedicated NIU at 1-800-575-5999.
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.