Not all U.S. states mandate infertility insurance coverage, but some states do, like New Jersey. This is great news for hopeful parents who live here. To help you make the most of your coverage, Everleap Fertility is here to explain the NJ IVF mandate. Discover what the mandate requires insurers to cover and how to find out if you’re eligible.

What is the New Jersey IVF mandate?

Fertility care can be expensive, but the NJ IVF mandate can help. It requires insurance policies to cover the diagnosis and treatment of infertility if:

• The insurance plan covers more than 50 people.
• The plan also provides pregnancy-related benefits.

Both of these things must be true for the NJ IVF mandate to apply.

What does the NJ IVF mandate require insurers to cover?

The New Jersey IVF mandate requires certain insurance plans to cover necessary fertility tests and treatments. What is medically necessary is determined by a physician and guidelines from the American Society for Reproductive Medicine (ASRM).

Hopeful parents interested in IVF should know that they may need to pursue “all reasonable, less expensive, and medically appropriate treatments” first.

Some plans have this requirement, and others do not. Additionally, the plans with this requirement may have different definitions of what is “medically necessary.” As a result, you will need to review the language of your plan for specific details.

Fertility care copayments, deductibles, and benefit limits will also vary depending on your specific medical and surgical benefits.

You can learn more about fertility coverage in New Jersey (and other US states) from this resource.

What are the eligibility requirements under the mandate?

The mandate requires coverage for those who have infertility. According to ASRM, the following groups are eligible for infertility coverage under the mandate:

• A man who cannot impregnate a woman
• A woman under age 35 who has a male partner and cannot conceive after 12 months of unprotected sexual intercourse
• A woman over age 35 who has a male partner and cannot conceive after six months of unprotected sexual intercourse
• A woman under age 35 without a male partner who does not conceive after 12 failed cycles of medically supervised IUI
• A woman over age 35 without a male partner who does not conceive after six failed cycles of medically supervised IUI
• Those who cannot conceive due to involuntary medical sterility (often seen in patients who have had chemotherapy or radiation)
• Someone who cannot successfully carry a pregnancy to term

What are exclusions to the mandate?

It’s important to note that this mandate requires eligible insurance plans to cover fertility care, regardless of a person’s relationship status or sexual orientation.

However, there are some exclusions from the NJ IVF mandate. These include:

• Patients with infertility due to voluntary sterilization procedures, such as a vasectomy or tubal ligation
• Egg or sperm donation costs when treatment is a choice and not medically necessary to overcome issues with egg or sperm quality
• Egg or sperm freezing when it is not medically required (for example, wanting to freeze eggs or sperm to postpone childbearing for reasons related to career, education, or relationships)
• Storage of frozen eggs or sperm
• Experimental or investigational infertility treatment

The mandate also exempts employers with fewer than 50 employees and self-insured employers. Religious employers also do not have to cover fertility care.

How do you verify your benefits?

To make sure you know what your policy does and does not cover, you should verify your benefits. One way to do this is to contact your insurance provider’s customer service line or use your provider’s online portal.

Before reaching out, make sure you have the following information ready:

• Patient name, date of birth, and address
• Member ID and group number
• Subscriber name (if different than the patient)

As you speak with a representative, it can be helpful to ask these questions:

• Does my plan cover infertility testing and treatment?
• Is my preferred doctor “in-network”?
• What is my annual deductible, and how close am I to meeting it?
• What out-of-pocket costs can I expect to pay for this medical service?
• Do I need prior authorization (approval) from the insurance company before pursuing treatment?

Everleap Fertility also has a billing and benefits team. These caring, helpful team members can help you learn more about your fertility care coverage.

What should you do if your plan isn’t covered by the NJ IVF mandate?

It can be disappointing to learn that your plan isn’t required to provide coverage under the New Jersey mandate. However, it’s still possible to access the care you need to start or grow your family.

Many Everleap Fertility locations offer flexible fertility financing programs. These plans vary by location and allow you to pay for treatment over time with manageable monthly payments.

Fertility grants can also help make care more affordable. For example, RESOLVE: The National Infertility Association offers fertility treatment grants and scholarships. The Chick Mission also offers grants for cancer patients pursuing fertility preservation.

Take the first step on your path to parenthood

The NJ IVF mandate is helping more patients become parents by offering increased coverage for infertility testing and treatment.

If you’re ready to explore fertility treatments at Everleap Fertility, we invite you to contact us today with your insurance information. Our team can help you schedule a consultation and answer questions about your coverage and the cost of fertility care.