On May 1, 2017 NJ Governor Chris Christie signed into law legislation improving insurance requirements for infertility coverage expanding who is eligible to receive coverage.
What a great day for fertility rights in New Jersey! Our very own Serena Chen, M.D. states “It is so exciting that the work that we have been doing along with ASRM and Resolve to improve access to care and access to IVF has come to fruition in New Jersey. We still have a long way to go but this update to the current law removes much of the discrimination in the old law and will improve health equity and access for many people who want families in New Jersey. We need to continue this work because many people in the U.S. who want children and need IVF and assisted reproduction to conceive safely still do not have good coverage or access.”
What the expansion means:
The existing statute required insurance providers that cover at least 50 people and provide pregnancy-related benefits to pay for infertility diagnosis and treatment. It defined infertility as a disease or condition that results in the abnormal function of the reproductive system such that: a male is unable to impregnate a female; a female under 35 years of age is unable to conceive after 2 years of unprotected sex; a female 35 years of age and over is unable to conceive after one year of unprotected sexual intercourse; the male or female is medically sterile; or the female is unable to carry a pregnancy to live birth.
The new statute updates the definition of infertility to “a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to ASRM guidelines (American Society for Reproductive Medicine) or by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology; or that the patient has met one of the following conditions:
- A male is unable to impregnate a female;
- A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
- A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;
- A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;
- A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;
- Partners are unable to conceive as a result of involuntary medical sterility;
- A person is unable to carry a pregnancy to live birth; or
- A previous determination of infertility pursuant to the law.”
These provisions of the new law are effective 90 days after enactment.
Additionally, the new law requires health plans contracting to cover state employees and teachers to include the same fertility coverage, effective immediately, and applies its provisions to contracts that are in force or that are issued or renewed after May 1, 2017.
These important changes mean not only that the new law falls in line with the medical definition of infertility, but that women with same sex partners and women without partners can now qualify for fertility coverage.
Here at IRMS we applaud these changes! For years, we’ve been working diligently alongside our colleagues in the fertility community to demand greater Access to Care. We are extremely excited and proud of this great step forward in protecting fertility rights for all of us that live in New Jersey and want to grow our families.
For more information about fertility insurance coverage and care, please give us a call at 973-322-8286 or contact us through our contact form. We have the experts available to help!