New York Expands IVF and Fertility Preservation Coverage

On January 1, 2020, a New York Law expanding in vitro fertilization, or IVF, coverage and fertility preservation services went into effect. Specifically, New York Insurance Law §§ 3221(k)(6)(C) and 4303(s)(3) mandates large group insurance policies and contracts of more than one hundred employees provide medical coverage to cover three cycles of IVF used in the treatment of infertility. Meanwhile, New York Insurance Law §§ 3216(i)(13)(C), 3221(k)(6)(C), and 4303(s)(3) require individual, small, and large group insurance policies provide fertility preservation services for people with iatrogenic infertility.

Under these laws, some required benefits include coverage of prescription drugs associated with IVF services, comprehensive care of fertility preservation services, including medically necessary egg and embryo storage until three required IVF cycles are provided, and access to fertility preservation services for those who are about to undergo gender-affirming care. Insurers may subject IVF and fertility preservation services to deductibles, co-payment, or coinsurance as long as the cost-sharing is consistent with other benefits in their policy but may not impose annual dollar limitations. Further, insurers may require prior authorization for these services and prescription drugs may be subject to the insurer’s formulary drug requirements.

How Frier Levitt Can Help
Providers, including fertility clinics and pharmacies that provide specialized fertility care, should be aware of the effect of this expansion of IVF and fertility preservation coverage services for its patients. Contact Frier Levitt today to speak to an attorney today.

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