Insurers are required to cover the diagnosis and treatment of correctable medical conditions and shall not exclude coverage of a condition solely because the medical condition results in infertility. Private, group health insurance plans, issued or delivered in the state of New York providing coverage for hospital care or surgical and medical care are required to provide coverage for the diagnosis and treatment of infertility. Certain procedures are excluded from this requirement, including reversal of elective sterilization, sex change procedures, cloning, and experimental procedures. Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility. Private health plans operating in the large group market (employers with 100 or more full-time staff) must provide coverage for up to three cycles of in-vitro fertilization, including necessary medications, even if the plan does not have a pharmaceutical benefit.
Individual, small and large group plans must cover fertility preservation services (egg or sperm retrieval, cryopreservation and storage) for patients at risk for iatrogenic infertility.
Insurers are not permitted to impose an annual dollar limit and are prohibited from discriminating in providing benefits based on an insured person’s age, expected life span, disability, other health conditions, or personal characteristics such as age, sex, sexual orientation, marital status or gender identity.
(New York Consolidated Laws, Insurance, Section 3221(k)(6), Section 3216(i)(13), Section 4303(s).)