The Family Building Act requires insurance policies that cover more than 50 people and provide 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 two years of unprotected sex (female partner under the age of 35) or one year of unprotected sex (female partner over the age of 35) or the inability to carry a pregnancy to term.
Coverage includes, but is not limited to:
- Diagnosis & diagnostic tests
- In vitro fertilization (IVF)
- Embryo transfer
- Artificial insemination
- Gamete intra fallopian transfer (GIFT)
- Zygote intra fallopian transfer (ZIFT)
- Intracytoplasmic Sperm Injection (ICSI)
- Four completed egg retrievals per lifetime
- Standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
Coverage for IVF, GIFT and ZIFT is required 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.
The law allows religious organizations to request an exclusion of this coverage if it is contrary to the religious employer's bona fide religious tenets. (New Jersey Permanent Statutes: 17B:27-46.1X Group Health Insurance Policies; 17:48A-7W Medical Service Corporations; 17:48-6X Hospital Service Corporations; 17:48E-35.22 Health Service Corporations; 26:2J-4.23 Health Maintenance Organizations)