Legislation Mandates Large Group Insurance Coverage of IVF and Coverage for Medically Necessary Fertility Preservation
Department of Financial Services Analysis Addresses Incorporating IVF Coverage into Infertility Mandate
Coverage Ensures that Fertility Services Are More Accessible to All, Regardless of Marital Status, Sexual Orientation, Gender Identity, Age, or Socio-Economic Status
Governor Andrew M. Cuomo today announced a proposal in the 2019 Women’s Justice Agenda to advance legislation to expand access to coverage for In Vitro Fertilization, as well as medically necessary fertility preservation services. This legislation will specifically mandate that large group insurance providers cover IVF services and will also require large group, small group, and individual insurance providers to cover egg-freezing services for women with certain health conditions, including those undergoing cancer treatment. Additionally, the legislation will include robust non-discrimination language to ensure that New Yorkers have access to these vital services, regardless of marital status, age, sexual orientation and/or gender identity. This follows the analysis from the Department of Financial Services feasibility study released today that was directed by the Governor as part of last year’s Women’s Agenda.
«New York is fighting to protect and expand reproductive health access to all New Yorkers – regardless of age, race, sexual orientation, gender identity or socioeconomic status,» Governor Cuomo said. «Mandating large health insurers cover IVF and fertility preservation services will remove many of the economic barriers people face when deciding when or how to start a family, and furthers our nation-leading women’s justice agenda.»
«Without insurance coverage, the high cost of in vitro fertilization is prohibitive, creating an unfair fertility tax imposed upon society,» said Lieutenant Governor Kathy Hochul. «Expanding the availability of IVF is a part of our Women’s Justice Agenda, a groundbreaking effort to ensure full equality for the women of our state. Every New Yorker hoping to build a family, regardless of financial means, should be given a chance to do so. All individuals should be able to access the latest in medical advances no matter who they love or what their income is.»
Melissa DeRosa, Secretary to the Governor and Chair of the Council on Women and Girls, said, «There is nothing more personal or life altering than the ability to conceive and making the choice about when to conceive. As someone who is currently facing these life altering decisions, I know firsthand the toll they take — emotionally and financially. We should be doing everything we can to help lessen that burden for all women, and this bold proposal takes a giant step forward in that fight.»
Acting Financial Services Superintendent Linda A. Lacewell said, «DFS is proud to support the Governor’s efforts through a sound approach to insurance regulation. These steps represent a measured extension of important reproductive health care coverage, with benefits that will have a positive impact for many New York families.»
IVF is an important benefit for people who face fertility obstacles, including same-sex couples and single women. Infertility affects about 10 percent of couples, and approximately 12 percent of women struggle to conceive or carry a pregnancy to term. Mandating IVF coverage will make the service more widely available to all, regardless of marital status, sexual orientation, gender identity, or socio-economic status. Fertility Preservation is in important benefit for cancer or other patients in treatment that may impact their ability to have children. While some employers provide coverage for these benefits, many do not and cost is the primary barrier to receiving these services.
Last year, Governor Cuomo directed DFS to examine approaches for incorporating IVF coverage into the existing infertility coverage mandate in New York. During the review process, DFS surveyed existing coverage and laws in other states and hired an actuarial vendor, Wakely Consulting, Inc., to conduct a financial analysis and project potential premium impacts of providing such coverage. The study takes into account the importance of such coverage, the demand for services, and premium impact, as well as other benefits, including support for women’s and same-sex equality in the workforce.
DFS Analysis
DFS reviewed options amending the Insurance Law’s definition of infertility to include coverage for medically-necessary fertility preservation services, including storage costs, for cancer or other patients who go through treatment that may affect their fertility. DFS also analyzed the following parameters for IVF coverage:
Cycle Limits: If an IVF mandate includes a cycle limit, «cycle» can be clearly defined.
Prohibit Discrimination Based on Marital Status, Sexual Orientation, and Gender Identity: IVF benefits can be written in such a way to ensure that full access is granted to everyone regardless of their marital status, sexual orientation, or gender identity. Benefits must be available for unmarried persons and same-sex couples, consistent with current DFS policies.
Age Limits: Consider IVF benefits that are not limited based on age. IVF coverage can be reviewed based on the patient’s medical needs, giving consumers the right to pursue an external appeal under current New York law. Therefore, consider not applying New York’s current upper age limit (to the age of 44) for infertility treatments.
Prohibit Procedural Hurdles: Currently, other states require exhaustion of other assisted reproductive technology (ART) procedures before IVF coverage is permitted. Each type of procedure has its own risks and rewards; therefore, the statute should not include these limitations, but permit a medical necessity review of treatment. This way, the decision as to which treatment(s) and when would be determined by medical necessity decisions, and the review would give consumers the right to pursue an external appeal under current New York law.
This proposal is included in the Governor’s 2019 Women’s Justice Agenda. This bold, comprehensive set of proposals builds on the success of the Governor’s 2018 accomplishments to improve reproductive, economic and social justice for all New York women. The full 2019 Women’s Justice Agenda is available here.