Fertility Insurance & Benefits in New York City

Understanding Fertility Insurance Coverage in New York State

In New York, insurance coverage for fertility care can vary based on the specific insurance plan. New York State law requires large-group insurance plans to cover the diagnosis and treatment of infertility, including in vitro fertilization (IVF). However, this mandate does not apply to small groups, individual plans, or employers who self-insure, so coverage under those plans may be more limited.

It's important for individuals seeking fertility treatment in New York to review their insurance plan carefully and speak with their insurance provider to understand what is covered and any potential out-of-pocket costs. At RMA of NY, our financial coordinators can help patients navigate insurance coverage and explore other financial options.

What fertility treatments are typically covered by insurance?

Insurance coverage for fertility care typically includes diagnostic services, such as testing to determine the cause of infertility, and various treatments like ovulation induction (OI), intrauterine insemination (IUI), and in vitro fertilization (IVF).

Criteria for Coverage

Insurance coverage for fertility care in New York is subject to specific criteria for eligibility, including diagnosis requirements and treatment limitations. While the state mandates coverage for certain treatments like IVF under large group insurance plans, there are still restrictions and limitations to consider. These may include age limits, restrictions on the number of IVF cycles covered, and requirements for prior authorization. It's important to review your insurance policy and speak with your provider to understand the criteria for coverage and any potential out-of-pocket costs.

RMA of New York is proud to be recognized as a “Center of Excellence” by Aetna, the New York State Empire Plan for Government Employees, and United Healthcare. Being chosen as a Center of Excellence means that our fertility center has met certain criteria set by the insurer to deliver high-quality, cost-effective care for infertility, including clinical outcomes, patient satisfaction, use of state-of-the-art IVF practices and technologies, and cost efficiency.

Fertility Care Insurance FAQs

• What types of fertility treatments are typically covered by insurance?

  Insurance coverage for fertility treatments varies but often includes diagnostic services like testing for infertility causes, as well as treatments such as ovulation induction (OI), IUI, and IVF. Coverage limitations, including age restrictions, cycle limits, and prior authorization requirements, may apply. It's important to review your insurance policy to understand what treatments are covered and any associated costs.

• How can I find out if my insurance covers fertility treatments?

  To find out if your insurance covers fertility treatments, review your policy documents or contact your insurance provider directly. Ask specifically about coverage for diagnostic services, ovulation induction, IUI, and IVF. Inquire about any restrictions or limitations, such as age limits, cycle caps, and prior authorization requirements. Understanding your coverage can help you plan for potential out-of-pocket costs and navigate the fertility treatment process more effectively.

• What should I do if my insurance does not cover fertility treatments?

  If your insurance does not cover fertility treatments, explore other options such as payment plans, financing programs, or grants. You may also want to speak with an RMA of New York financial coordinator who can evaluate your unique situation further and also explore out-of-network coverage on your behalf. Consider consulting a financial advisor to discuss budgeting and loan options. Additionally, some employers offer fertility benefits or flexible spending accounts (FSAs) that can help offset costs.

• How can I maximize my insurance coverage for fertility treatments?

  To maximize your insurance coverage for fertility treatments, start by understanding your policy's benefits and limitations. Work closely with RMA of New York's financial coordinators, who can help you navigate the insurance process. They can assist in obtaining pre-authorizations, appealing denials, and exploring alternative financing options. Consider using flexible spending or health savings accounts to cover eligible expenses, and explore grants or other programs for fertility treatment if available.