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NJ Insurance Mandate

New Jersey Family Building Act (NJ Mandate)

In 2001, the State of New Jersey became one of 15 states mandating coverage for infertility testing and treatment. The NJ Family Building Act (referred to as the NJ Mandate) requires some NJ-based employers to cover infertility related medical services including:

  • diagnostic testing 

  • ovulation induction

  • fertility medications (even if not included in prescription plan)

  • unlimited Intrauterine Insemination (IUI)

  • Up to 4 completed egg retrievals for In Vitro Fertilization (IVF)

  • IVF + ICSI, assisted hatching, GIFT and ZIFT

  • egg donor or gestational carrier procedures related to IVF

NJ Infertility Insurance Mandate Inclusions and Exclusions

Employers with less than 50 employees, who are self-insured, not based in New Jersey or who object to the mandate on religious or ethical grounds are exempt from the mandate.

Additionally, the mandate does not cover individuals who have undergone elective sterilization procedures such as tubal ligation or vasectomy. Nor does it cover compensation paid to egg donors or gestational carrier recruiting agencies.

Gestational Carrier costs are covered, but surrogacy is not, since traditional surrogacy is not legal in New Jersey. Cryopreservation (freezing) of eggs, sperm and embryos is not covered. Experimental treatments and non-medical costs such as ovulation and sperm testing kits are also not covered by the NJ Mandate.

​LGBT Coverage under the NJ Mandate

 

The good news is that the Department of Banking and Insurance (DOBI) has since clarified that coverage cannot be denied for same sex couples or single women who have failed 6 or more donor IUI cycles.

Affording IVF without Mandate Coverage

Most important to note is that our in-house Financial Coordinator will meet with you personally to discuss your policy details and coverage once IVF has been identified in your treatment plan.

 

We work hand in hand with our patients on an individual basis to provide financial assistance in the form of payment plans, discounts, and financing options not available elsewhere. 

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