New Jersey Leads the Charge for Better Fertility Treatment Insurance Coverage

Living in the Garden State has its perks—full-service gas stations, Cape May, and Bruce Springsteen to name a few. Another one? It’s 1 of only 16 US states that has coverage laws for fertility treatment. So, if you live or work in New Jersey, part of your fertility treatment is probably covered. Let’s dig into that a little.

Whom do these laws apply to?

Generally, if your employer is fully insured, has more than 50 employees, and is located in New Jersey, they are required to offer certain fertility treatment coverage benefits.

If you are covered by a family member’s health insurance plan, and that plan is written in the state of New Jersey or is written for a fully insured employer with more than 50 employees located in New Jersey, it is required to offer certain fertility treatment coverage benefits.

Are you covered by New Jersey’s state mandate to cover fertility treatment?

If you live in New Jersey and work for an applicable employer located in New Jersey, the state mandate applies to the plan provided by your employer.

If you live in New Jersey but work for an employer located outside New Jersey, you may need to contact your employer’s benefits provider to figure out the coverage available to you.

Are there any exceptions to these laws?

If your employer is a religious organization or a self-insured business—that is, they do not use an external insurance plan provider, like Aetna or Blue Cross, and pay insurance claims themselves—they are exempt from the state mandate.

And, if you are 46 or older and/or your fertility challenges are a result of voluntary sterilization procedures, these laws will not be applicable to you.

What’s covered by this mandate?

While the exact coverage varies from plan to plan, group insurers, HMOs, the State Health Benefits Program, and the School Employees Health Benefits program are required to provide coverage for, but not limited to:

  • Testing and diagnosis
  • Artificial insemination
  • Fresh and frozen embryo transfers
  • 4 completed egg retrievals (per lifetime)
  • IVF (with your own eggs, donor eggs, and where a surrogate is used)
  • ICSI (intracytoplasmic sperm injection)
  • GIFT (gamete intrafallopian transfer)
  • ZIFT (zygote intrafallopian transfer)
  • Medications prescribed for treatment
  • Medications prescribed to induce ovulation
  • Surgery, including microsurgical sperm aspiration

Good to know: In order to use these benefits, you must seek treatment from or have these procedures performed at facilities that comply with ACOG (American College of Obstetricians and Gynecologists) and ASRM (American Society for Reproductive Medicine) guidelines.

This is great—but now what?

Now it’s time for research—find out if your plan falls under the requirements of New Jersey’s coverage mandate.

A great next step would be to talk to the financial specialist at your reproductive endocrinologist’s (RE’s) office to find out what’s covered and how much you may need to pay out of pocket. If your RE doesn’t have a financial specialist on staff, call your insurance benefits provider. And if you don’t yet have an RE, we have you covered. Use our interactive tool to find a specialist in your area.

That’s a lot to talk about. Where do I even begin?

Insurance can get hairy, and you want to be sure that you cover some key points. These questions can be a good start.