New York Insurance Law

New York lawmakers passed updates to existing insurance mandates. Learn how this new insurance law impacts people with infertility and cancer patients.

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Millions of New Yorkers have a chance of a family. Because of the hard work of RESOLVE advocates and our coalition partners, New York State lawmakers passed major updates to the existing insurance law that would impact people with infertility, those who struggle to build a family, and cancer patients who want to protect their future fertility.

"This is finally recognition that IVF is the standard of care for many who are struggling to build a family. Having New York change its insurance law is going to be a game-changer for the rest of the country.”- Barbara Collura, President/CEO, RESOLVE: The National Infertility Association

So, what does the change to the New York insurance law actually do? Watch while we break it down here in this video.

Just to recap, this new law applies to:

People who get their health insurance from a fully-insured employer who has coverage on the Large Group market controlled by New York State. These are companies with 100 or more employees.

How many cycles are covered?

Three. This new law provides up to 3 IVF cycles, whether it be a fresh embryo transfer or frozen embryo transfer.

What else should I know?

The update provides coverage for medically necessary fertility preservation treatments. Which means infertility caused by a medical intervention such as radiation, medication, or surgery. This means freezing sperm or eggs before those medical procedures. The updated law also prohibits denial of coverage for IVF or fertility preservation because of age, sex, sexual orientation, marital status, and gender identity.

If you are unsure if this law applies to you, open enrollment is a great time to verify these benefits with your HR department or benefits manager. Consider sharing this video to make sure they are aware of these changes.

If you don’t fit in to one of these scenarios please check out our extensive Coverage at Work resources.

Have more questions? Learn more about this new law here or email info@resolve.org.

Frequently Asked Questions:

What does the change to New York insurance law actually do?

The passage of the 2020 New York state Budget includes a major update to existing insurance laws that impact people with infertility, those that struggle to build a family, and cancer patients that want to protect their fertility.

The updated insurance law, which takes effect January 1, 2020, does the following:

"After 22 years of fertility nursing I am overjoyed to know my patients will now have the insurance coverage they need to fulfil their dreams and the outpouring of support from the fertility community for this cause was overwhelming." – Chris Gray RN, BSN, CNY Fertility Center, Latham, NY

How is this different from the Fair Access to Fertility Treatment Act (FAFTA) and why was this passed in the NY State Budget?

FAFTA, which is a bill RESOLVE and a coalition of organizations have been advocating for, was introduced in the New York Assembly by Aravella Simotas and in the New York Senate by Diane Savino. FAFTA did not limit how many IVF cycles would be covered and FAFTA provided IVF coverage to all commercial plans, including plans in the Individual and Small Group markets.

In early 2019, Governor Cuomo included an IVF proposal in his proposed budget and the New York State Senate included FAFTA in its budget. A three-way budget negotiation took place among the Senate, Assembly and Governor, and the Governor’s proposal was ultimately accepted and approved in the NY State Budget

Who does the law help?

The law helps people in NY who have health insurance from a NY-based employer that has a fully insured Large Group plan (100+ employees). This is approximately 2.5 million New Yorkers. People covered include:

The law helps anyone who is facing iatrogenic infertility and needs to preserve their sperm or eggs, who is covered by a fully insured Small Group or Large Group plan, or an Individual plan. This includes people who get their insurance through the Exchange (Obamacare). This is approximately 4.7 million New Yorkers. This part of the law only addresses the medical procedures that are “standard fertility preservation procedures” and does not cover an embryo transfer. Standard fertility preservation procedures are not defined in the law.

"Finally, I am able to give the state-of-the-art treatment patients so deserve, instead of recommending IVF but having finances preventing my patients from accessing the appropriate care they need." – James Stelling, MD, Island Fertility, Commack, NY

Who does the law leave out?

The law leaves out anyone who needs IVF and gets their health insurance from a fully-insured Small Group plan (less than 100 employees), is covered by an Individual plan, or anyone who receives their health insurance in New York from the Exchange (Obamacare). For both IVF and Fertility Preservation, the law also leaves out people who are covered by Medicaid in New York, health insurance provided by the Federal government, such as TRICARE and Federal employees, and Veterans. It also leaves out anyone who needs IVF or fertility preservation and receives their health insurance from an employer that is self-insured, which is typically employers that have over 1,000 employees; this is due to federal law, which impacts any insurance law passed in any state. Ask your employer’s HR or benefits staff if your employer is fully-insured or self-insured. If your employer is self-insured, they can choose to cover IVF and fertility preservation. RESOLVE has resources to help you ask for this coverage from your self-insured employer.

Why doesn’t this update to the existing infertility law cover the same things FAFTA covered?

The FAFTA bill included coverage for IVF for everyone in commercial plans in the fully-insured market (Individuals, Small, and Large Group plans.) A little-known provision in the Affordable Care Act (ACA) has made it challenging for states to pass new insurance laws. However, states can update existing insurance laws, which is what the Governor and Legislature did in the NY Budget. The last time the insurance law for infertility treatments was updated in NY was in 2002. Fertility preservation for women didn’t even exist in 2002. Given the unique way the NY law was written in 2002, some deemed FAFTA as a new mandate, which made it very difficult to get coverage for the Individual and Small Group markets (which includes the Exchanges/Obamacare). RESOLVE is helping states identify ways to update their insurance laws within the guidelines of the ACA, and we will continue to seek a solution to the unique issue in NY.

"As the Chairperson of the Alliance for Fertility Preservation, I’m so pleased to see that these patients recently diagnosed with a life-threatening but treatable disease are not having to make a choice between staying alive or having a family. It’s a true victory for our patients and I can say that I am truly proud to be a New Yorker." -Glenn Schattman, MD, Weill Cornell Medicine, New York, NY

Does this impact the New York State Infertility Demonstration Program?

New York State has offered a grant program for qualifying NY residents who have health insurance that does not cover IVF. This update to the existing NY insurance law does not impact the Infertility Demonstration Program.

"New Yorkers who need medical help to build their families – today and in the future – owe a huge debt of gratitude to RESOLVE and its network of supporters who have petitioned for so long to bring logic and fairness to the existing, but outdated, insurance law." – Richard Grazi,MD, GENESIS Fertility, Brooklyn, NY

How we got this done!

Victories like this one do not happen overnight. Advocacy is a marathon, not a sprint, and like a marathon, there are hills and valleys, and people helping you along the way, and even some who get in your way.

In 2016, RESOLVE was able to secure the services of an experienced lobbying firm in Albany, which made a huge difference by having people on the ground representing our interests these past 3+ years. That year, RESOLVE helped draft legislation to update NY’s current infertility insurance law and formed a coalition of like-minded organizations and companies, including the American Society for Reproductive Medicine (ASRM), Alliance for Fertility Preservation, EMD Serono, and Ferring Pharmaceuticals. The coalition has since grown to more than 50 supporting organizations.

We hosted our first Advocacy Day in Albany in 2016, and every year thereafter. This past February we held our largest NY Advocacy Day with 100 advocates traveling from across the state to meet with their lawmakers. RESOLVE and our coalition partners also made more than a dozen trips to Albany to meet with our bill sponsors, key Committee members, and top officials in Governor Cuomo’s Administration. Because of our communications and grassroots mobilizing strategies, lawmakers received 2,259 letters from their constituents urging them to support FAFTA.

"One of the things that, to me, is most powerful about this incredible achievement is the overwhelming majority of those who advocated for this bill will not directly benefit from it. In fact, many who pushed hardest for FAFTA to be passed have reached their family building resolution whether it was through IVF, adoption, surrogacy or even childfree but they went to Albany, contacted their lawmakers, posted on social media, etc. because they want those after them to have the fair shot at having a family that perhaps they, themselves did not. That’s the power and bond of the infertility community." – Jay Palumbo, Blogger, Advocate, New York Resident

As a result, FAFTA passed twice in the Assembly, in 2017 and 2018, and an amended version that we did not support passed the Senate in 2018. The legislative session ended in 2018 before they were able to reconcile the differences in the two bills, so we started over again in the 2019-20 legislative session.

In addition to grassroots advocacy, the Coalition commissioned studies to determine the cost of adding IVF and fertility preservation coverage and to learn what other states have done to update their insurance laws within ACA guidelines.

And last, but not least, we seized every opportunity to shine a spotlight on infertility and the lack of insurance through media interviews and op-eds. By amplifying the voice of the patient, we were able to overcome opposition by much larger, better-funded opponents, such as the NY health insurance plans.

"To have our voices truly heard in New York is a remarkable feeling and I’m so grateful to the RESOLVE team for including me in such an empowering community of advocates." – Kienan Robinson, Advocate, New York Resident

Closing Thoughts

Change does not happen overnight, and it does not come without a dedicated community working together towards a common goal–#Access2Care. As you can see from the lists and links below, it took the combined commitment of a coalition of passionate patients and professionals to give New Yorkers a fair shot at family! Now millions more New Yorkers have the peace of mind that if they find themselves struggling to build a family, they are covered. That’s what access is, peace of mind – by removing cost as a barrier to care.

"It is hard to keep fighting, year after year, with no success. But I kept telling myself, the only way to ensure that nothing positive happens is to quit. So I kept on working, kept going up to Albany, kept asking my friends and social networks for support, kept contacting supportive legislators and members of the governor’s administration. I had a two-pronged approach: fight for good legislation, and fight for good legislators. This year, we had a confluence of both, and look what happened. I’m so glad we never gave up, and we never will - we will continue to fight to improve this legislation until all New Yorkers, and all Americans, have the much-needed coverage for their diseases." – Risa Levine, RESOLVE Board of Directors, New York Resident

Coalition to Help Families Struggling with Infertility – Founding Members in addition to RESOLVE:

The following Professionals and Organizations attended one or more New York Advocacy Days in Albany, NY from 2016-2019, as well as assisted with advocacy efforts in support of FAFTA:

In addition to the medical practices listed above, the following practices assisted the Coalition in multiple ways by advocating for FAFTA:

The organizations below joined the Coalition and/or sent a letter of support: