S.6118-A/A.6177-A – IVF Mandate

This legislation, S.6118-A/A.6177-A, would expand New York’s existing law that mandates health plans provide coverage of in vitro fertilization (IVF). The New York Health Plan Association (HPA) opposes this legislation because it will be extremely difficult to operationalize and it expands an already expensive health insurance mandate, which will result in increased costs and increased premiums at a time we are seeking affordability.

Our member health plans recognize the importance of coverage of certain treatments to families struggling with fertility. New York law currently has generous insurance coverage of fertility treatments for New Yorkers, including requirements for coverage of fertility preservation services without regardless of marital status, age, sexual orientation and/or gender identity. It also requires that large group policies cover three cycles of IVF.

New York’s existing coverage requirements are based on a detailed 2019 study by the Department of Financial Services that analyzed how best to include IVF in the state’s existing infertility coverage mandate. That report included noted that: “If an IVF mandate includes a cycle limit, ‘cycle’ can be clearly defined within the statute.” It goes on to say, “a ‘cycle’ is defined as either all treatment that starts: (1) when preparatory medications used for ovarian stimulation with the intent of undergoing IVF are administered for oocyte retrieval, IVF using fresh embryo transfer; or (2) with medications for endometrial preparation with the intent of undergoing IVF with a frozen embryo transfer.”

This bill seeks to expand the definition of “cycle” to be “completed oocyte retrievals” and to include “unlimited embryo transfers from fresh or frozen oocytes or embryos from a covered retrieval.” Unlimited embryo transfers from a covered retrieval is extremely hard to track due to the difficultly of being able to verify which cycle the embryos came from.

The bill further states “coverage shall not be denied based on a covered individual’s participation in fertility services provided by or to a third party.” The sponsors’ memo indicates this expansion is necessary to extend IVF coverage to LGBTQ+ couples because gay men are not covered, nor are lesbian couples “where neither partner will undergo IVF.” While plans appreciate the rights of LGBTQ+ New Yorkers to avail themselves of existing infertility coverage, this broad expansion will essentially create a benefit of unlimited transfers. Moreover, in cases where couples use both a donor egg and gestational carrier, it is not feasible to track cycle counts.

The 2019 DFS study on including IVF to the state’s existing infertility coverage estimated the mandate would cost approximately $110 million dollars annually. By greatly expanding IVF coverage, this legislation would also greatly increase these costs. Increasing the underlying cost of health care ultimately drives up health insurance premiums.

Affordability of health insurance remains a key concern for employers and consumers. Health plans are committed to working on efforts aimed at preserving affordability and encourage lawmakers remain focused on making health care more affordable for all New Yorkers.

For all the reasons stated above, we urge you to say no to S.6118-A/A.6177-A