On May 1, 2017, Gov. Christie signed into law SB 1398, creating Chapter 48. The new law expands the availability of insurance coverage for infertility-related health benefits to certain women who are currently denied coverage for those benefits. Current NJ law requires coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility, but the definition of “infertility” requires the female to have unprotected intercourse (and therefore excludes certain females, such as lesbians, women without partners or women with partners who have protected intercourse). To include those individuals, the new bill restructures the definition of “infertility” to mean diseases or conditions that result in abnormal function of the reproductive system, infertility based on the determination of a NJ-licensed physician, or that a plan participant meets one of the following conditions:
- Male plan participants who are unable to impregnate females,
- Female plan participants who are under age 35 and have male partners who can’t conceive after 12 months of unprotected sexual intercourse,
- Female plan participants who are 35 years of age or older and have male partners who can’t conceive after six months of unprotected sexual intercourse,
- Female plan participants who are under age 35 and don’t have male partners and can’t conceive after 12 failed attempts of medically supervised intrauterine insemination,
- Female plan participants who are over age 35 and don’t have male partners and can’t conceive after six failed attempts of medically supervised intrauterine insemination,
- Plan participants’ partners who can’t conceive because of involuntary medical sterility,
- Plan participants who are unable to carry a pregnancy to live birth, or
- Plan participants who previously have been determined to be infertile.
It’s also important to note that coverage for medically necessary diagnosis and treatment of infertility does not include infertility resulting from voluntary sterilization procedures.
Also, tax-exempt religious employers (including churches or groups that are controlled, operated or supervised by churches) may exclude coverage for artificial insemination, embryo transfer, intracytoplasmic sperm injection, in vitro fertilization and zygote intrafallopian transfer, if such coverage is contrary to the religious employer’s religious belief.
The new requirements are effective for insured group health plans issued or renewed on or after July 31, 2017. NJ employers with fully insured plans should work with carriers on any questions relating to the new infertility coverage requirements.
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