NJ Fertility Mandate: IVF Insurance Coverage with the Family Building Act

New Jersey State Mandate – The Family Building Act

New Jersey State Mandate requires insurance policies that cover more than 50 people and provides pregnancy-related benefits to cover the cost of the diagnosis and treatment of infertility. The law defines infertility as the disease or condition that results in the inability to get pregnant after one year of unprotected sex (female partner under the age of 35) or six months of unprotected sex (female partner over the age of 35) or the inability to carry a pregnancy to term. Insurance plans must be fully-funded, and the headquarters of the employer must be in New Jersey.

Coverage includes, but is not limited to:

  • Diagnosis & diagnostic tests
  • Medications
  • Surgery
  • In vitro fertilization (IVF)
  • Embryo transfer
  • Artificial insemination (IUI)
  • Intracytoplasmic Sperm Injection (ICSI)
  • Four completed egg retrievals per lifetime

Does Insurance Cover IVF?

Coverage for IVF is only if:

  • The patient has used all reasonable, less expensive and medically appropriate treatments and is still unable to get pregnant or carry a pregnancy.
  • The patient has not reached the maximum number of allowed egg retrievals and the patient is 45 years of age or younger.
  • The procedures are performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.