Large Group Insurers to Cover IVF in 2020

In April 2019, Governor Andrew Cuomo highlighted the Fiscal Year 2020 Enacted Budget which includes an expansion of coverage for in-vitro fertility services and medically appropriate fertility preservation. This coverage promotes safe and affordable reproductive health care while removing a costly barrier to family planning. While large-group insurers are required to offer the option, employers are not required to include it in the plans offered to employees.

According the National Conference of State Legislators, only 30% of states in the US require insurance providers to cover infertility treatments*. Of that, only five require them to cover in-vitro fertilization (IVF). In 2020, New York will join that list. Effective January 1, 2020, large-group insurance providers (those with over 100 employees) must cover up to three cycles of in-vitro fertilization (IVF) and every policy including prescription-drug coverage must include FDA-approved drugs for use in the diagnosis and treatment of infertility. Additionally, large-group, small-group, and individual insurance providers must cover medically necessary fertility preservation services (that is, egg or sperm freezing) for those facing iatrogenic infertility, meaning fertility is compromised by a medical treatment such as chemotherapy, medications or surgeries.

Excluded from this mandate is anyone who is covered through a fully-insured, small-group plan (less than 101 employees) or an individual plan, and anyone insured through New York State of Health (New York’s Obamacare marketplace). The law also excludes people covered by Medicaid, federally-provided health insurance, federal employees, veterans and those covered by a self-funded employer plan.

IVF and fertility preservation services are costly. The process is not only financially taxing, it’s emotionally taxing, too. The average cost of one in-vitro fertilization cycle is over $12,000; and this doesn’t include the cost of medications, which can run up to $3,000 each. First attempts are not always successful so multiple cycles may be necessary. Historically, families have spent retirement savings, taken out loans, run up credit-card debt, asked family members for financial help, and increasingly looked to crowdfunding websites.  Adding up the financial, emotional and physical stress, it is understandable why New Yorker’s made IVF coverage a top priority in their lobbying efforts.

Thanks to the new mandate, 2.4 million New Yorkers will have access to IVF coverage, and more than 4 million will have access to fertility preservation before undergoing treatment for cancer or other medical treatments.

According to conversations with carriers, this new reproductive health coverage will increase the cost of employer-provided health insurance by1.5%. We suggest identifying the demand for fertility coverage amongst your employee population and reviewing your current benefits offerings to determine if adding IVF coverage to your plan would be beneficial.

*The information contained in this communication is not legal or tax advice and is not a substitute for such advice. State and federal law change frequently, and knowledge of each person’s unique fact situation is always needed to determine how the law will apply.

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