Measure to Expand Fertility Coverage in NJ Now Law

(TRENTON) – Legislation sponsored by Assemblywoman Joann Downey to increase fertility coverage for New Jersey families has been signed into law.

Under current law, hospital, medical and health service corporations, commercial group insurers and health maintenance organizations are required, in certain circumstances, to provide coverage under group policies for medically necessary expenses incurred in the diagnosis and treatment of infertility. However, under the current definition of infertility certain women, such as same sex partners, women without partners, or women with partners who have protected intercourse, are not qualified to receive coverage for these benefits.

“No one should be denied health coverage. Period,” said Downey (D-Monmouth). “Women starting families, whether single or in a same-sex relationship or married, should receive the support they need from their health care provider.”

The law (A-1447) requires the State Health Benefits Program and the School Employees Health Benefits Plan to provide expanded availability of insurance coverage for infertility-related health benefits.

Under the law, the definition of infertility is restructured so as to require coverage for the medically necessary expenses for the diagnosis and treatment of infertility, by defining “infertility” to mean: a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine practice guidelines by a physician who is Board Certified or Board Eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology; or that the patient has met one of the following conditions:

1) a male is unable to impregnate a female;

2) a female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;

3) a female with a male partner and 35 years of age and over is unable to conceive after six months of unprotected sexual intercourse;

4) a female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of intrauterine insemination under medical supervision;

5) a female without a male partner and over 35 years of age who is unable to conceive after six failed attempts of intrauterine insemination under medical supervision;

6) partners are unable to conceive as a result of involuntary medical sterility;

7) a person is unable to carry a pregnancy to live birth; or

8) a previous determination of infertility pursuant to the law.

The current statutory definition of infertility requires a woman under the age of 35 to have unprotected intercourse for at least two years without being able to conceive, a woman over the age of 35 to have unprotected intercourse for one year without being able to conceive, or a partner to have been deemed medically sterile or unable to carry a pregnancy to live birth. Women who do not meet the current definition for infertility are denied coverage for these benefits.