New Year,
New You
Q&A:
Fertility Insurance
Benefits 2022
Does your current healthcare plan offer infertility coverage? If so, not all insurance coverage for infertility is the same by employer or state.
While most US states lack laws requiring insurance providers and employers to cover the diagnosis and treatment of infertility, here in the state of New York, many patients will have coverage that ranges from clinical work-up to IUI and all the way to IVF.
Effective January 1, 2020, New York Insurance Law §§ 3221(k)(6)(C) and 4303(s)(3) required that large group insurance policies provide medical, major medical, or similar comprehensive-type coverage and are delivered or issued for delivery in New York to cover three cycles of IVF used in the treatment of infertility. According to the NYS mandate the definition of large group means a group of more than 100 employees.
Now two years later, we’re seeing many patients take advantage of the new law, but still lingering questions remain.
We had the opportunity to speak with Robert Mbonye, MHA who leads their patient finance team at Generation Next Fertility about infertility insurance do’s and don’ts as 2022 unfolds.
What can infertility patients do to manage their financial health and maximize their healthcare benefits?
Ask a lot of questions, and document your conversations. Before anything – a consultation or IVF cycle, patients should meet with someone in their HR department or benefits administrator to review what your company plan offers.
Next, you should call your insurance company to confirm what you discussed with your HR contact. Sometimes, people make innocent interpretations and assumptions so make sure you’re all on the same page. Finally, work with the fertility center to have them confirm and validate your benefits and level of coverage.
If I’m an infertility patient in New York City, which plans offer better plans?
First thing first, there are a gazillion different insurance plans that a single insurance provider may offer. So, just because your friend who had Aetna had very little out of pocket costs for her last IVF cycle, doesn’t mean that you will too. Her employer almost certainty purchased a different plan than your company.
