In 2001, the Family Building Act was signed into law in New Jersey. The law requires New Jersey health insurance policies, riders and endorsements that cover groups other than small employers (less than 50 employees) and provide pregnancy-related benefits to cover the cost of the diagnosis and treatment of infertility. The law defines infertility as the disease or condition that results in the abnormal function of the reproductive system such that:
- A male is unable to impregnate a female;
- A female under 35 years of age is unable to conceive after two years of unprotected sexual intercourse;
- A female 35 years of age and over is unable to conceive after one year of unprotected sexual intercourse;
- The male or female is medically sterile; or
- The female is unable to carry a pregnancy to live birth.
What will this law cover? Infertility coverage includes, but is not limited to, payment of benefits for the following services and procedures recognized by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
- Artificial insemination with no limit as to the number of cycles;
- Assisted hatching;
- Diagnosis and diagnostic tests;
- Fresh and frozen embryo transfer;
- Four completed egg retrievals per lifetime of the covered person;
Where a donor is used in the egg retrieval, the medical costs of the donor shall be covered until the donor is released from treatment by the reproductive endocrinologist;
Egg retrievals where the cost was not covered by any carrier shall not count in determining whether the four completed egg retrieval limit has been met;
- Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT);
- Intracytoplasmic sperm injections (ICSI);
- In vitro fertilization (IVF), including in vitro fertilization using donor eggs and in vitro fertilization where the embryo is transferred to a gestational carrier or surrogate;
- Medications, including injectable infertility medications, even if the contract or policy does not provide prescription drug benefits. Where a contract or policy provides both prescription drug and medical and hospital benefits, infertility drugs shall be covered under the prescription drug coverage;
- Ovulation induction; and
- Surgery, including microsurgical sperm aspiration.
Self-insured insurance groups are exempt from the state mandate.
Our financial counselors would be happy to answer any questions you have. More information is also available by going to: http://www.resolvenj.org/FBAIsLaw.html Our experienced financial counselors will guide you through the process of managing the financial end of the treatment. They are available to meet with you before treatment begins and at any point during your care. For more information, please call us at 201-634-5400 or e-mail us at firstname.lastname@example.org.