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New Jersey Infertility Insurance Mandate

New Jersey is one of 15 states that has an infertility insurance mandate in place, which requires insurance plans to offer or to provide coverage for fertility treatment costs or IVF costs. New Jersey law on fertility treatment and IVF insurance coverage can be found under Title 17 of the New Jersey Permanent Statutes.

New Jersey infertility insurance law was signed into effect in 2001. Called the Family Building Act, the New Jersey fertility treatment insurance law states that any insurance policy that covers more than 50 people and provides pregnancy-related benefits must also cover the costs related to infertility diagnosis and fertility treatments. IVF costs are also covered under New Jersey law.

New Jersey fertility treatment insurance law clarifies the definition of infertility. According to the section, infertility refers to 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.

The infertility insurance mandate requires insurers to cover the costs of the following: 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), and four completed egg retrievals per lifetime of the covered person.

New Jersey Infertility Insurance Mandate Limitations

Like many of the states that have infertility insurance mandates in place that require coverage for fertility treatments and IVF costs, New Jersey law contains a number of stipulations for coverage. According to New Jersey law, assisted reproduction procedures like IVF, GIFT, and ZIFT may only be covered if the following conditions are met:

  • The person has used all reasonable, less expensive, and medically appropriate fertility treatments and still has been unable to conceive or carry a pregnancy to term
  • The person has not reached the maximum of four completed egg retrievals
  • The patient is under the age of 45
  • The fertility treatment are performed at fertility clinics or medical centers that conform to the guidelines put in place by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists

Religious organizations are exempt from the requirement to provide coverage for IVF, embryo transfer, artificial insemination, ZIFT, and ICSI, if those fertility treatments go against their religious tenets.

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