The New Jersey infertility mandate formally called the New Jersey Family Building Act was enacted in 2001 and requires that any health insurance policy that covers more than 50 people and covers pregnancy related benefits must also cover costs related to infertility diagnosis and treatment. It covers a wide range of diagnostic and treatment procedures, included IVF with ICSI making it one of the most friendly states for men who suffer from infertility.
Further information is clarified in the New Jersey Family Building Act. A summary of eligibility requirements, exemptions and services covered is outlined below.
How the mandate defines infertility
The New Jersey mandate defines infertility as ” the disease or condition that results in the abnormal functioning of the reproductive system, in which a person is unable to impregnate another person, become pregnant by trying to conceive with unprotected sexual intercourse after two years if the woman is younger than 35, or one year of unprotected sexual intercourse if the woman is 35 or older, or carry a pregnancy to produce a live birth.”
Patient requirements: Patient must be under 45 and have infertility as defined above.
Clinic Requirements: IVF procedure must be performed at a fertility clinic or medical facility that conforms to standards and guidelines set by the American Society for Reproductive Medicine (ASRM) or the American College of Obstetricians and Gynecologists.
How the law treats male infertility
The New Jersey Mandate is one of the most progressive in terms of recognizing that infertility affects men and women equally. The law specifically acknowledges male infertility by stating that infertility is “..condition that results in the abnormal functioning of the reproductive system, in which a person is unable to impregnate another person…” It explicitly covers medication and surgeries which are the primary treatment options available to men and covers use of ICSI in an IVF cycle.
Services that are covered
The law specifies that less expensive options should be exercised prior to use of more costly procedures.
The following treatments are specifically listed in the law:
- Fertility tests and diagnostics
- Fertility medications
- Fertility surgery
- In vitro fertilization (IVF)
- Embryo transfer
- Artificial insemination
- Gamete intrafallopian transfer (GIFT)
- Zygote intra fallopian transfer (ZIFT)
- Intracytoplasmic sperm injection (ICSI).
Limitations on coverage
A woman has a lifetime limit of 4 egg retrievals.
The following are exempt from providing coverage:
- Small employers (< 50 employees)
- Self-insured plans
- Organizations that oppose these treatments on religious/ethical grounds
- Couples who have a had a permanent elective sterilization procedure (tubal ligation or vasectomy)
- Companies not based in New Jersey
- Compensation paid to egg donors, surrogates or recruiting agencies
Tips & Resources
Having a law in place goes a long way to help ensure that you can access treatment should you need it but navigating insurance can be tricky and dedicating a little bit of time to understanding your benefits and your options can help you make a plan that you and your partner feel good about.
Get to know your insurance plan: If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what your out-of-pocket costs are likely to be.
Take advantage of other health benefits you may have: such as HSA/FSA accounts, preventative health services and wellness programs offered through your insurance. Getting healthy as possible can improve the health of your unborn child and potentially improve your chances of conceiving (naturally or with treatment).
Additional Resources: There are several organizations that support people who have trouble getting pregnant including Fertility within Reach (focused on helping people navigate insurance issues) and Resolve (that does both advocacy and peer-led patient support groups). You may also be able to connect with other people in your area via our local forum boards.
- Fertility Authority: New Jersey Infertility Mandate
- Resolve: Insurance coverage by State
- National Conference of State Legislatures: State Laws related to insurance coverage for infertility treatment
- New Jersey Family Building Act